Neurosurgeons use adult stem cells to grow neck vertebrae

 

Neurosurgery researchers at UC Davis Health System have used a new, leading-edge stem cell therapy to promote the growth of bone tissue following the removal of cervical discs — the cushions between the bones in the neck — to relieve chronic, debilitating pain.

The procedure was performed by associate professors of neurosurgery Kee Kim and Rudolph Schrot. It used bone marrow-derived adult stem cells to promote the growth of the bone tissue essential for spinal fusion following surgery, as part of a nationwide, multicenter clinical trial of the therapy.

Removal of the cervical disc relieves pain by eliminating friction between the vertebrae and/or nerve compression. Spinal fusion is used following surgery for degenerative disc disease, where the cushioning cartilage has worn away, leaving bone to rub against bone and herniated discs, where the discs pinch or compress nerves.

“We hope that this investigational procedure eventually will help those who undergo spinal fusion in the back as well as in the neck,” said Kim, who also is chief of spinal neurosurgery at UC Davis. “And the knowledge gained about stem cells also will be applied in the near future to treat without surgery those suffering from back pain.”

Millions of Americans are affected by spine diseases, with approximately 40 percent of all spinal fusion surgery performed for cervical spinal fusion. Some 230,000 patients are candidates for spinal fusion, with the numbers of potential patients increasing by 2 to 3 percent each year as the nation’s population ages.

“This is an exciting clinical trial to test the ability of the bone-forming stem cells from healthy donors to help patients with spinal disease,” said Jan Nolta, director of the UC Davis Institute for Regenerative Cures.

“For the past 50 years, bone marrow-derived stem cells have been used to rebuild patients’ blood-forming systems. We know that subsets of stem cells from the marrow also can robustly build bone. Their use now to promote vertebral fusion is a new and extremely promising area of clinical study,” she said.

The stem cell procedure at UC Davis took place early in August. The patient was a 53-year-old male from the Sacramento region with degenerative disc disease.

In the surgery, called an anterior cervical discectomy, a cervical disc or multiple discs are removed via an incision in the front of the neck. The investigational stem cell therapy then is applied to promote fusion of the vertebrae across the space created by the disc removal.

The stem cells are derived from a healthy single adult donor’s bone marrow, and thus are very homogenous, Kim said. They are grown in culture to high concentration with minimal chance for rejection by the recipient, he said.

Adequate spinal fusion fails to occur in 8 to 35 percent or more of patients, and persistent pain occurs in up to 60 percent of patients with fusion failure, which often necessitates additional surgery.

“A lack of effective new bone growth after spine fusion surgery can be a significant problem, especially in surgeries involving multiple spinal segments,” said Schrot, co-principal investigator for the study. “This new technology may help patients grow new bone, and it avoids harvesting a bone graft from the patient’s own hip or using bone from a deceased donor.”

Current methods of promoting spinal fusion include implanting bone tissue from the patient’s hip or a cadaver to encourage bone regrowth as well as implanting bone growth-inducing proteins. However, the Food and Drug Administration has not approved the use of bone morphogenetic proteins for cervical spinal fusion. Their use has been associated with life-threatening complications, particularly in the neck.

The leading-edge stem cell procedure is part of a prospective, randomized, single-blinded controlled study to evaluate the safety and preliminary efficacy of an investigational therapy: modified bone marrow-derived stem cells combined with the use of a delivery device as an alternative to promote and maintain spinal fusion.

The study includes 10 investigational centers nationwide. The UC Davis Department of Neurological Surgery anticipates enrolling up to 10 study participants who will be treated with the stem cell therapy and followed for 36 months after their surgeries. A total of 24 participants will be enrolled nationwide.

The study is one of several clinical trials under way in the UC Davis Spine Center and led by Kim. He anticipates launching a clinical trial soon to study the safety of injecting stem cells into disc tissue to repair degenerated discs.

The current study is sponsored by Mesoblast, Ltd., of Melbourne, Australia, which is developing adult universal-donor stem cell products built upon the discovery of adult-derived mesenchymal precursor cells. Kim and Schrot will not be compensated for their participation in the study.

At Miami Stem Cell, our US Board Certified Team of Doctors are experts at treating neck and back injuries using Stem Cell Therapy. To learn more, visit: www.stemcellmia.com or call (305) 598-7777 for a free evaluation.

Platelet-rich plasma injections: an emerging therapy for chronic discogenic low back pain

Autologous platelet-rich plasma (PRP) injections have been investigated in recent years as an emerging therapy for various musculoskeletal conditions, including lumbar degenerative disc disease. Although PRP has received increasing attention from medical science experts, comprehensive clinical reports of its efficacy are limited to those treating knee osteoarthritis and epicondylitis. Use of PRP is gaining popularity in the area of degenerative disc disease, but there is a clear need for reliable clinical evidence of its applications and effectiveness. In this article, we review the current literature on PRP therapy and its potential use in the treatment of chronic discogenic low back pain, with a focus on evidence from clinical trials.

Discogenic low back pain

Low back pain is one of the major causes of physical disability affecting both older and younger people and can have enormous socioeconomic and health impacts. One of the major causes of low back pain is age-associated intervertebral disc degeneration (,), which affects the nervous system around the disc. Stimulation of the nociceptors in the annulus fibrosus causes pain, which is termed “discogenic” pain (). Interestingly, degeneration, endplate injury and inflammation can stimulate pain receptors inside the disc, leaving the external disc intact (). Intervertebral disc degeneration can be described as an active process involving changes in tissue and the cellular microenvironment that eventually lead to structural breakdown and impairment of intervertebral disc function ().

Reported pathologic features of painful discs include the formation of zones of vascularized granulation tissue with extensive innervation in annular fissures (). Due to the avascular nature of intervertebral discs and, hence, their limited ability to regenerate, research on the regeneration of intervertebral discs and the various associated treatment methods has increased. Raj et al. [2008] () reported that various biochemical changes occur during disc degeneration, including loss of proteoglycan, loss of collagen fibers, increased fibronectin, increased enzymatic activity, increased fragmentation of collagen, proteoglycan and fibronectin, and changes in nutritional pathways. Histologic examination of painful discs has revealed the formation of a zone of vascularized granulation tissue extending from the nucleus pulposus to the outer part of the annulus fibrosus along the edges of the annular fissures, and growth of nerves deep into the annulus fibrosus and nucleus pulposus ().

Disc degeneration is accompanied by changes in the matrixes of both the nucleus pulposus and the inner annulus fibrosus that are mediated by an inflammatory process (). Nociceptive stimuli include pro-inflammatory cytokines produced by disc cells [such as interleukin (IL)-1, IL-4, IL-6, IL-8, IL-12, IL-17], interferon-γ, tumor necrosis factor (TNF)-α, downstream signaling molecules such as nitric oxide (NO), leukotrienes, prostaglandin E and by-products of disc cell metabolism such as lactic acid (). Disc degeneration can also be caused by aging, apoptosis, vascular ingrowth, failure of nutrient supply to disc cells, abnormal mechanical loads or genetic factors (,). Rather than simply providing symptomatic relief, it is important to understand the pathophysiology of degenerated discs to determine the most effective treatment of the underlying cause.

Current treatments for discogenic back pain

As extensively reviewed by Raj et al. () and Simon et al. (), a number of methods are used for the management of discogenic low back pain (Table 1). Since it is widely believed that degenerated discs are the source of discogenic pain, treatments mostly focus on surgical procedures such as fusion and total disc replacement. The reliability and effectiveness of these surgical procedures are still debated, as they are reported to only offer pain relief (). Alternatively, non-invasive methods such as benign neglect, physical therapy or symptom control with medication or injection have been employed to treat discogenic pain. Notably, these treatments do not improve the underlying degenerative condition, although they do resolve its symptoms (). This clearly indicates the need for new therapies and/or interventions that actually treat the underlying causes of discogenic pain. Accordingly, increased attention has been given to emerging techniques such as growth factor therapy, and biomolecular and cellular treatments.

To read the entire article, please click on the link below:

https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5911760/

 

Keywords: Platelet-rich plasma (PRP), chronic back pain, discogenic, disc degeneration

Degenerative Disc Disease: Steroids Vs Stem Cell Therapy

 

 

 

Degenerative Disc Disease is the blanket term that describes the conditions arising due to the general wear and tear of inter-vertebral discs. It usually presents as pain in the lower back, buttocks or thighs which lasts from several days to a few months. Patients find that no particular position relieves the pain and it worsens when they sit down. Our day to day activities, posture, diet and genetic makeup dictate the onset and worsening of the disease.

Our spine is made of a string of 33 bones called vertebrae which are connected to each other through ligaments and intervertebral discs. In between two vertebra there are fluid filled discs which act as shock absorbent and provide the spine, its flexibility. With progressing age, the discs undergo wear & tear, lose its fluid content and sponge like quality and thus flexibility. These discs have a very limited blood supply which is just enough to sustain them and help withstand occasional minor disturbances. However, repeated trauma can lead to hardening of these discs and development of cracks in them which becomes a source of constant neck or lower back pain. On MRI scans, degenerated discs appear darker relative to normal discs.

Discogenic pain “disc related pain” in degenerative disease is usually localized around the offending disc(s) and doesn’t radiate far from its location.  This pain is thought to arise due to new nerve endings growing inside the disc after developments of cracks (fissures) through normal daily wear and tear or through trauma. Discogenic pain presents as a deep-seated pain around the spine and typically no particular position appears to relieve pain.

Interventional pain management procedures for discogenic pain

Interventional pain procedures like like Discography or Provocative discogram can help pinpoint the offending disc(s). Discography is a interventional procedure during which we create pressure inside individual disc(s) under X-ray guidance to duplicate patient’s everyday pain. Discography is mainly used to diagnose the particular disc as offending agent for pain.

Pain due to Disc Herniation arises when a disc develops cracks or in medical terminology ‘fissures, bulge, protrusion, extrusion’ and the leaking disc contents put pressure on the surrounding nerves. Patient might experience shooting pain or sciatica like symptoms with pain radiating down from the neck to the arm or down their leg from the lower back as the herniated disc causes nerve irritation. As the discs have very little blood supply of their own, over the counter pain relievers or other oral medications provide very limited pain relief in these cases.

Epidural Steroid Injections, a type of interventional pain management procedure is an effective way to relieve pain caused by herniated discs. Steroids, which are powerful anti-inflammatory medications when injected around the herniated disc provide relief by reducing the sensitivity of the nerve ending and reducing inflammation around the disc herniation and protrusion allowing the body’s natural healing process to work. Although Epidural injections are helpful for relieving Sciatica symptoms caused by disc herniation, they provide limited help for localized low back pain originating from deep seated disc issues ie degenerative disc disease presenting as Discogenic pain.

Traditionally, treatment options for Discogenic Pain have mostly been surgical in nature and aim to provide pain relief without actually addressing the root cause of the condition. Some options available are:

  • Micro Discectomy, where the intrusive inter-vertebral disc fragments are removed via surgery
  • Spinal Fusion Surgery, where vertebrae surrounding the offending disc(s) are fused. This provides pain relief by limiting movement of the affected disc(s). However, the fused vertebrae divert pressure to other areas of the spine and over the years, patients develop problems above or below the fusion level adding to herniation, stenosis or spondylosis.
  • Total Disc Replacement, as the name implies, involves replacement of the natural disc with an artificial one. Studies show that the outcomes for this surgery are similar to that observed with Spinal Fusion Surgery.

Regenerative Therapy

Regenerative therapy is another treatment modality that has been gaining popularity for treatment of Degenerative Disc disease. Platelet Rich Plasma (PRP) therapy is a kind of Regenerative therapy that has been successfully used in many studies to reduce Discogenic low back pain. It involves injecting a small amount of growth factor rich fraction of your blood inside the offending disc(s).

The growth factors activate and expedite the natural healing processes of the body, healing the discs from within and relieving pain. Stem Cell Therapyanother regenerative therapy uses Mesenchymal Stem Cells derived from a patient’s bone marrow to repair Degenerated Discs. Several cases have been reported where the discs have been repaired to normal disc heights alleviating the patient’s disc related pain in as little as 6 months.

For more information on the treatments that we offer, contact Miami Stem Cell www.stemcellmia.com

 

2018: A Very Successful Year at Stem Cell Miami By: Ingrid Machado CFO of Stem Cell Miami

2018: A Very Successful Year at Stem Cell Miami

By: Ingrid Machado  

CFO of Stem Cell Miami

As 2018 is coming to an end, we are extremely happy to report that throughout this entire year we have seen exceptional results in the clinical application of our signature Regenerative Medicine Treatments at our acclaimed Stem Cell Miami Institute with now over 8000 procedures successfully completed up to date!

In 2018, not only did we continue to successfully increase the number of autologous Stem Cell Procedures conducted, but we also surpassed our PRP (Platelet Rich Plasma) applications, as well as fully employing our latest addition to our pain relief arsenal: Orthobiologics, a new innovative procedure that does not require any blood extraction or sedation. These new powerful placenta derived products have reliably proven to be extremely effective to control pain with many of our patients and regardless of their age. These new biological products have also been successfully used in conjunction with our premier PRP Treatments to create our signature powerful “cocktail” that has immensely improved overall results to treat a wide range of medical symptoms.

(more…)

Translate »