This morning that subject is disc stem cell therapy. Yesterday a patient on a discussion board about biologic orthopedics jumped in on a complex expert discussion of stem cells to treat low back discs. While it’s easy to assume that patients have a good understanding of the complexity of spine care, I’m frequently reminded that they can get duped easily. Why? Physicians can spend a lifetime learning about the spine and still not completely understand it’s nuances. The smart physicians get to the point where they know what they don’t know, the not so smart ones assume they know everything there is to know. Such is the nutty world of emerging stem cell care for degenerative disc disease.

Why not just inject the disc? Putting a hole in the disc should never be a first, second, or even third line treatment. While it may be the answer for some patients, it’s significantly more invasive than not injecting the disc (i.e. placing growth factors epidural or into ligaments). In addition, at least one large study has suggested that this small hole could cause more disc degeneration in the long run. While for the right patients this approach may be a God send, for many it’s unnecessary and if the right things aren’t injected in the right disc, we may see more and not less disc degeneration. In fact, several recent studies have shown that common contrast agents used in discography (the procedure that puts the stem cells into the discs) are toxic to the cells inside the disc (study 1study 2study 3). So when stem cells are used in discs, they need to be placed such that these contrast agents are washed out of the disc.

The upshot? Getting to an accurate diagnosis of what’s causing pain in most complex patients takes hours of physician time and not minutes. Don’t get bamboozled by any physician who spends a few minutes looking at your MRI and proposes invasive care based on that picture. Disc stem cells hold some promise for treating the right patients, but no clinical study to date has shown that a patient with a collapsed and degenerated disc will regrow a new disc with a magic stem cell injection!

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