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What evidence is there to support BMC stem cell injections for spine health?
Bone marrow concentrate is a rich source of stem cells, including mesenchymal stem cells that go on to create bone, cartilage, and the tissue that makes up the intervertebral discs. As such, there has long been interest in using injections of bone marrow concentrate (BMC) to facilitate repair of damaged tissue in the spine.
Cell-based therapy using BMC is proving to be a promising, accessible, and cost-effective approach to regenerative treatment of intervertebral discs (Wang et al., 2010). The anti-inflammatory and immunomodulatory properties of bone marrow stem cells promotes tissue regeneration and can enhance the quality of cartilage repair by increasing aggrecan content and tissue firmness (Sampson et al., 2013).
Laboratory studies have found that culturing mesenchymal stem cells from bone marrow alongside degenerated cells from the nucleus pulposus (the gel like material inside the spinal discs) increased the production of proteoglycan and collagen-type II, which would benefit tissue repair to create stronger, healthier spinal discs (Svanvik et al., 2010)
In one animal study, a combination injection of basic fibroblast growth factor (bFGF), transforming growth factor-Β1 (TGF-Β1), bone marrow mesenchymal stem cells, and temperature-responsive chitosan hydrogel (TCH) gel was clearly seen to promote repair of degenerative intervertebral discs (Jiang et al., 2015). Not only did the bone marrow stem cells survive in the degenerative intervertebral disc, they were found to differentiate into nucleus pulposus-like cells, helping to restore the shape and, therefore, function of the spinal discs.
Numerous laboratory studies and clinical trials have found that bone marrow derived stem cells may support the regeneration of damaged spinal nerve pathways and promote remyelination of nerves (Goel, 2016). In one randomized controlled trial involving 40 patients with cervical spinal cord injury, half of the patients who received bone marrow mesenchymal stem cell transplantation had significant motor and sensory improvements and improved bladder function as measured on the American Spinal Injury Association Impairment Scale (AIS), with no significant adverse effects seen after six months (Dai et al., 2013).
BMC injections may be useful in conditions such as osteoradionecrosis (ORN), a potential complication of radiotherapy, including in the treatment of head and neck cancers. In one case study, injections of BMC into the mandible of a patient with this noninfectious, necrotic condition resulted in complete bone remodeling 1 year after treatment and no further symptoms in the patient (Manimaran et al., 2014).
One large study following over 2,000 patients demonstrates the safety of stem cell injections for orthopedic conditions, with very few adverse reactions overall and the lowest rate among those undergoing BMC treatment (Centeno et al., 2016). Those adverse reactions noted were confined for the most part to pain following the procedure and due to progressive joint disease.
Scientists have long known that there is an age-related decline in the population of mesenchymal stem cells in bone marrow, and in the efficacy of these stem cells (Ajiboye et al., 2015). What this means for anyone undergoing spinal surgery is that the older you are the more difficult it is for your body to effectively build bridging bone between a bone graft and existing tissue, for example, or to heal other types of damaged tissue in the spine.
The use of bone marrow stem cells in older patients undergoing spinal fusion has been associated with successful outcomes, however. Bone marrow concentrate offers an effective injectable material rich in a patient’s own stem cells.
The use of BMC as a bone graft material is now well established, following early studies in animals. More recently, animal studies have shown that BMC bone grafts provide increased biomechanical behavior compared to other grafts, thereby significantly strengthening the vertebral body (Manrique et al., 2014).
Bone marrow concentrate has been used for many years to assist spinal fusion surgery, proving particularly helpful in boosting the success of procedures involving an allograft (donor bone) (Johnson, 2014; Robbins et al., 2014).
In one study, 31 elderly patients (65 and older) underwent posterolateral and interbody lumbar fusion using bone marrow concentrate with an allograft and demineralized bone matrix. In 83.9% of cases, patients had evidence of a successful fusion, with 96.8% of interbody fusions successful. None of the patients had complications related to hardware or morbidity at the graft donor site, and excellent or good results were seen for 83.9% of patients (Ajiboye et al., 2015).
Ajiboye, R.M., Hamamoto, J.T., Eckardt, M.A., Wang, J.C. (2015). Clinical and radiographic outcomes of concentrated bone marrow aspirate with allograft and demineralized bone matrix for posterolateral and interbody lumbar fusion in elderly patients. Eur Spine J, Nov;24(11):2567-72.
Badrinath, R., Bohl, D.D., Hustedt, J.W., Webb, M.L., Grauer, J.N. (2014). Only prolonged time from abstraction found to affect viable nucleated cell concentrations in vertebral body bone marrow aspirate. Spine J, Jun 1;14(6):990-5.
Centeno, C.J., Al-Sayegh, H., Freeman, M.D., Smith, J., Murrell, W.D., Bubnov, R. (2016). A multi-center analysis of adverse events among two thousand, three hundred and seventy two adult patients undergoing adult autologous stem cell therapy for orthopaedic conditions. Int Orthop. 2016 Mar 30. [Epub ahead of print]
Dai, G., Liu, X., Zhang, Z., Yang, Z., Dai, Y., Xu, R. (2013). Transplantation of autologous bone marrow mesenchymal stem cells in the treatment of complete and chronic cervical spinal cord injury. Brain Res, Oct 2; 1533():73-9.
Goel, A. (2016). Stem cell therapy in spinal cord injury: Hollow promise or promising science? J Craniovertebr Junction Spine, Apr-Jun;7(2):121-6.
Hustedt, J.W., Jegede, K.A., Badrinath, R., Bohl, D.D., Blizzard, D.J., Grauer, J.N. (2013). Optimal aspiration volume of vertebral bone marrow for use in spinal fusion. Spine J, Oct;13(10):1217-22.
Jiang, C., Li, D.P., Zhang, ZJ., Shu, H.M., Hu, L., Li, Z.N., Huang, Y.H. (2015). Effect of Basic Fibroblast Growth Factor and Transforming Growth Factor-Β1 Combined with Bone Marrow Mesenchymal Stem Cells on the Repair of Degenerated Intervertebral Discs in Rat Models. Zhongguo Yi Xue Ke Xue Yuan Xue Bao, Aug;37(4):456-65.
Johnson, R.G. (2014). Bone marrow concentrate with allograft equivalent to autograft in lumbar fusions. Spine (Phila Pa 1976), Apr 20;39(9):695-700.
Manimaran, K., Sankaranarayanan, S., Ravi, V.R., Elangovan, S., Chandramohan, M., Perumal, S.M. (2014). Treatment of osteoradionecrosis of mandible with bone marrow concentrate and with dental pulp stem cells. Ann Maxillofac Surg, Jul-Dec;4(2):189-92.
Robbins, S., Lauryssen, C., Songer, M.N. (2014). Use of Nanocrystalline Hydroxyapatite With Autologous BMA and Local Bone in the Lumbar Spine: A Retrospective CT Analysis of Posterolateral Fusion Results. J Spinal Disord Tech.Feb 27.
Manrique, E., Chaparro, D., Cebrián, J.L., López-Durán, L. (2014). In vivo tricalcium phosphate, bone morphogenetic protein and autologous bone marrow biomechanical enhancement in vertebral fractures in a porcine model. Int Orthop, Sep;38(9):1993-9.
Sampson, S., Botto-van Bemden, A., Aufiero, D. (2013). Autologous bone marrow concentrate: review and application of a novel intra-articular orthobiologic for cartilage disease. Phys Sportsmed, Sep;41(3):7-18.
Svanvik, T., Henriksson, H.B., Karlsson, C., Hagman, M., Lindahl, A., Brisby, H. (2010). Human disk cells from degenerated disks and mesenchymal stem cells in co-culture result in increased matrix production. Cells Tissues Organs, 191(1):2-11.
Wang, Y.T., Wu. X.T., Wang. F. (2010). Regeneration potential and mechanism of bone marrow mesenchymal stem cell transplantation for treating intervertebral disc degeneration. J Orthop Sci. 2010 Nov;15(6):707-19.