Is stem cell therapy for back pain effective? Our clinic has been treating low backs with stem cells longer than any in the world. Let’s review what we’ve learned in a decade and a half as well as what we both know and don’t know.
Centeno-Schultz was the First Clinic on Earth to Perform a Stem Cell Low Back Procedure
It was back in 2005 that I and my partner John Schultz performed the world’s first stem cell injection into a low back disc. We had high hopes that this would work. However, we were soon immediately disappointed and then later pleasantly surprised. Meaning that while we couldn’t replicate what the animal models showed by regrowing a new disc, we found years later that we could do other things like get rid of disc bulges. We also found that we could help many patients with platelets as well as stem cells. Through the years we also learned what worked and what to avoid.
The Many Causes of Back Pain
There are lots of things that cause low back pain and any discussion of stem cell therapy for back pain needs to review these first:
- Trigger points or atrophied stabilizing muscles or tendon pain. Meaning that the low back has the largest single muscle mass in the body. Hence, lots can go wrong in this category. The muscles themselves can develop tight and painful areas that don’t fire called trigger points. The muscles that stabilize the spinal segments can atrophy and this can cause sloppy movement of the vertebrae (see my video below). Finally, each of these low back muscles has tendons that attach to bone and these can become irritated and beaten up and also cause pain. (6)
- Sacroiliac Joint – The SI joint is the articulation between the tailbone and the back of the hip. It can become loose or sloppy after delivering a baby or with direct trauma (5). Check out the white ligaments here to the right. They surround and support the joint and these also link up with fibers from the hamstrings muscle below and the fascia that surrounds the low back above (the thoracodorsal fascia). When these ligaments are stretched, this can cause pain that refers to the back of the hip, groin, or even down the leg.
- Disc Problems – In this category we have Irritated or compressed nerves that may be caused by leaking, bulging or herniated discs. The low back discs act as a shock absorber between the backbones. They can be injured or just wear out over time. When that happens, the inner gel can leak out or herniate and this can irritate or compress nerves, leading to symptoms that run down the leg (sciatica). A disc bulge can also occur which is when the outer disc is damaged but the inner gel is contained which can also cause sciatica.
- Injured or damaged facet joints – There are left and right-sided finger-sized joints which live in the back of each disc level called “facet joints”. They can be injured by trauma or just normal wear and tear and can cause pain that stays in the low back or even refers down into the hip, thigh, or leg. (7)
- Spinal stenosis – There are holes in the vertebrae (backbones) where the nerves travel. When these get too small due to arthritic bone spurs, enlarged ligaments, or bulging discs, this is called stenosis. The nerves can get irritated or pressed at these areas leading to sciatica symptoms or an inability to stand.
- Degenerative Disc Disease (DDD) – There are discs that act as shock absorbers between the bones and these can get damaged or worn out. When this happens they can collapse and allow sloppy motion which leads to bone spurs (8). This can cause back pain or even sciatica.
Does Stem Cell Therapy Work for Back Pain?
To answer this critical question, I’ll include all many different regenerative low back therapies that are commonly offered, such as PRP (platelet-rich plasma), BMC (bone marrow concentrate), and cultured expanded stem cells (not yet available in the United States). Let’s dig in.
PRP stands for platelet-rich plasma which is made from concentrated platelets taken from the patients own blood, There’s actually pretty decent research supporting that platelet-rich plasma (PRP) can help several types of back pain. For example, we have a level 1 study that shows that PRP injected into the disc using imaging guidance can help reduce pain and increase function in patients with painful low back discs (9). Our research group at the Centeno-Schultz clinic has also published a study on the use a type of PRP preparation called platelet lysate that we have noted helps sciatica (radiculopathy) that is caused by herniated discs or bulging low back discs (12). These are highly precise injections using x-ray guidance around the irritated nerves (transforaminal epidurals). In addition, a small study that used before and after MRI has shown that PRP can improve the atrophy of the lumbar multifidus (low back stabilizing muscles) (11). Finally, PRP has also been shown to effectively treat SI joint problems and performed better than the more commonly used steroid shots (10). It’s for all of these reasons that we treat many patients who want stem cell therapy for low back pain with much less expensive and less invasive PRP treatments.
A same-day stem cell therapy for back pain is BMC also called BMAC or bone marrow concentrate. This is created by taking a bone marrow aspirate from the back of your hip and then pulling out the stem cell fraction in that bone marrow. BMC injection into the low back disc in one series of several studies was used to help improve pain and function in patients with painful discs (13). Our clinic has also used BMC to treat a wide variety of low back pain problems. This includes sacroiliac joint instability/pain, arthritic or damaged facet joints, and DDD (degenerative disc disease). However, we’ve noticed that the best application of this technology is in treating painful disc tears. In these patients, as in the study above, the patients often go from being unable to sit for more than 5 or 10 minutes to be able to sit for hours.
Finally, it’s possible to take the BMC procedure described above and grow the stem cells to greater numbers over several weeks. While this type of therapy is not yet permitted in the US due to FDA regulations, it is allowed elsewhere. Based on early animal models that showed that cultured stem cell injections demonstrated promise in regenerating damaged discs (16), our medical clinic published several research papers on the injection of this type of stem cells in patients. The focus here is reducing the size of bulging discs that are pressing on nerves without surgically removing part of the disc. These procedures were largely successful in helping patients avoid back surgery (14, 15). Other researchers have also published on the use of this type of cultured cells in the disc (17, 18). This procedure is now part of a phase 2 FDA study to obtain approval here in the United States and is currently offered by our clinic at a licensed facility in Grand Cayman.
The Use of Amniotic or Umbilical Cord Stem Cells for Back Pain
Right now, there are countless clinics advertising that they can inject millions of young and healthy stem cells from amniotic or umbilical cord sources. While an attractive idea, regrettably, the research on the products used by these clinics shows that the amniotic and umbilical cord products are all dead tissue and in particular have no living stem cells (1-3). In addition, there are no published studies on actual patients that show that using these amniotic or umbilical cord products in the spine would have any positive effects. So if you’re told at a seminar that there are loads of research studies that show that using these products in the spine is effective, that’s just not accurate.
Does Stem Cell Therapy Work for Degenerative Disc Disease?
Can stem cell injections regrow a completely collapsed and degenerated low back disc? The early research in this area on animals showed real promise that this would happen in humans (16). However, in actual patient studies, neither our clinic nor other researchers have noted reliable disc regeneration using stem cell injections. So at the end of the day, if you have a collapsed and degenerative disc, it is very unlikely that injecting stem cells will grow you a brand new disc. Having said that, it’s clear that many of these patients with DDD can be helped in other ways. If that’s your problem, watch my video below on how that works:
A Video and Book that Explains Things Further
I like creating videos to help my patients understand complex topics. As a result, I made a video presentation on this topic, so see below for more info:
I’ve also written a whole book on stem cell therapy for back pain, click below to download a copy of the book:
Is Stem Cell Therapy for Back Pain Covered by Most Insurance Plans?
Stem cell therapy for back pain is not covered by major health insurance carriers, Medicare, or Medicaid. However, our clinic is the national headquarters for a company called Regenexx that has had success in obtaining full coverage from various employers who offer self-funded health plans. Ask our clinic staff for more details.
Finally, if you’re really intrigued about this topic and want to watch an academic presentation I recently presented at a medical conference on the use of stem cells and platelets in the spine, feel free to watch my longer video below:
The upshot? Stem cell therapy for back pain and PRP are very real treatment options. They both represent an up and coming alternative to surgery. We have more experience than any clinic on earth offering these therapies to patients and on what works, and what doesn’t work. In addition, there is mounting research evidence that these procedures work.
(1) Berger D, Lyons N, Steinmetz, N. In Vitro Evaluation of Injectable, Placental Tissue-Derived Products for Interventional Orthopedics. Interventional Orthopedics Foundation Annual Meeting. Denver, 2015. https://interventionalorthopedics.org/wp-content/uploads/2017/08/AmnioProducts-Poster.pdf
(2) Becktell L, Matuska A, Hon S, Delco M, Cole B, Fortier L. Proteomic analysis and cell viability of nine amnion-derived biologics. Orthopedic Research Society Annual Meeting, New Orleans, 2018. https://app.box.com/s/vcx7uw17gupg9ki06i57lno1tbjmzwaf
(3) Panero, A, Hirahara, A., Andersen, W, Rothenberg J, Fierro, F. Are Amniotic Fluid Products Stem Cell Therapies? A Study of Amniotic Fluid Preparations for Mesenchymal Stem Cells With Bone Marrow Comparison. The American Journal of Sports Medicine, 2019 47(5), 1230–1235. https://doi.org/10.1177/0363546519829034
(4) Gianakos AL, Sun L, Patel JN, Adams DM, Liporace FA. Clinical application of concentrated bone marrow aspirate in orthopaedics: A systematic review. World J Orthop. 2017;8(6):491–506. Published 2017 Jun 18. doi:10.5312/wjo.v8.i6.491
(5) Vleeming A, Schuenke MD, Masi AT, Carreiro JE, Danneels L, Willard FH. The sacroiliac joint: an overview of its anatomy, function and potential clinical implications. J Anat. 2012;221(6):537–567. doi:10.1111/j.1469-7580.2012.01564.x
(6) Kalichman L, Carmeli E, Been E. The Association between Imaging Parameters of the Paraspinal Muscles, Spinal Degeneration, and Low Back Pain. Biomed Res Int. 2017;2017:2562957. doi:10.1155/2017/2562957
(7) Manchikanti L, Hirsch JA, Falco FJ, Boswell MV. Management of lumbar zygapophysial (facet) joint pain. World J Orthop. 2016;7(5):315–337. Published 2016 May 18. doi:10.5312/wjo.v7.i5.315
(8) White, A. A., & Panjabi, M. M. (1978). Clinical biomechanics of the spine. Philadelphia: Lippincott.
(9) Monfett M, Harrison J, Boachie-Adjei K, Lutz G. Intradiscal platelet-rich plasma (PRP) injections for discogenic low back pain: an update. Int Orthop. 2016 Jun;40(6):1321-8. doi: 10.1007/s00264-016-3178-3.
(10) Singla V, Batra YK, Bharti N, Goni VG, Marwaha N. Steroid vs. Platelet-Rich Plasma in Ultrasound-Guided Sacroiliac Joint Injection for Chronic Low Back Pain. Pain Pract. 2017 Jul;17(6):782-791. doi: 10.1111/papr.12526(
(11) Hussein M, Hussein T. Effect of autologous platelet leukocyte rich plasma injections on atrophied lumbar multifidus muscle in low back pain patients with monosegmental degenerative disc disease. SICOT J. 2016;2:12. Published 2016 Mar 22. doi:10.1051/sicotj/2016002
12) Centeno C, Markle J, Dodson E, et al. The use of lumbar epidural injection of platelet lysate for treatment of radicular pain. J Exp Orthop. 2017;4(1):38. Published 2017 Nov 25. doi:10.1186/s40634-017-0113-5
(13) Pettine KA, Suzuki RK, Sand TT, Murphy MB. Autologous bone marrow concentrate intradiscal injection for the treatment of degenerative disc disease with three-year follow-up. Int Orthop. 2017 Oct;41(10):2097-2103. doi: 10.1007/s00264-017-3560-9.
(14) Centeno C, Markle J, Dodson E, et al. Treatment of lumbar degenerative disc disease-associated radicular pain with culture-expanded autologous mesenchymal stem cells: a pilot study on safety and efficacy. J Transl Med. 2017;15(1):197. Published 2017 Sep 22. doi:10.1186/s12967-017-1300-y
(15) Elabd C, Centeno CJ, Schultz JR, Lutz G, Ichim T, Silva FJ. Intra-discal injection of autologous, hypoxic cultured bone marrow-derived mesenchymal stem cells in five patients with chronic lower back pain: a long-term safety and feasibility study. J Transl Med. 2016;14(1):253. Published 2016 Sep 1. doi:10.1186/s12967-016-1015-5
(16) Sakai D1, Mochida J, Yamamoto Y, Nomura T, Okuma M, Nishimura K, Nakai T, Ando K, Hotta T. Transplantation of mesenchymal stem cells embedded in Atelocollagen gel to the intervertebral disc: a potential therapeutic model for disc degeneration. Biomaterials. 2003 Sep;24(20):3531-41. DOI: 10.1016/s0142-9612(03)00222-9
(17) Noriega DC, Ardura F, Hernández-Ramajo R, Martín-Ferrero MÁ, Sánchez-Lite I, Toribio B, Alberca M, García V, Moraleda JM, Sánchez A, García-Sancho J. Intervertebral Disc Repair by Allogeneic Mesenchymal Bone Marrow Cells: A Randomized Controlled Trial. Transplantation. 2017 Aug;101(8):1945-1951. doi: 10.1097/TP.0000000000001484.
(18) Orozco L, Soler R, Morera C, Alberca M, Sánchez A, García-Sancho J. Intervertebral disc repair by autologous mesenchymal bone marrow cells: a pilot study. Transplantation. 2011 Oct 15;92(7):822-8. doi: 10.1097/TP.0b013e3182298a15.