Degenerative Disc Disease

Degenerative Disc Disease (DDD), as the name implies, refers to a condition characterized by pain and possible radiating weakness/numbness stemming from the degeneration or break down of a spinal disc, impinging on the nerve(s).  This disease occurs when an intervertebral disc loses its integrity and its ability to cushion spinal forces of body weight and during motion, eventually causing discomfort to the patient.  This condition is most commonly caused by age-related deterioration of intervertebral discs, causing the vertebrae to impinge during normal movements.  Eventually, owing to drying of the nucleus pulposus in the middle and loss of flexibility of the outer annulus fibrosis, and the chronic stresses exerted upon the disc itself from above and the surrounding vertebrae, the gelatinous material of the weakened disc(s) herniate. Herniation takes place at weak areas in the fibrous annulus, and the gelatinous material of the central fusion bulges and protrudes posteriorly into the spinal canal, encroaching upon the lumen contains the spinal cord and nerves. Other degenerative changes like spondylolisthesis (displacement) and osteophyte formation may result in further spinal stenosis and compression of nerves. Indeed, spinal stenosis and impingement are not prerequisite for pain and irritation in that region, since ligamentous sprains and tears, as well as facet inflammation, could cause same. Further, the spillage of the gelatinous nucleus pulposus itself may cause irritation, inflammation, and pain. Thus, back pain may be multifactorial. In some cases, DDD, with compression of a spinal nerve, can lead to symptoms in the territory of that nerve, which includes numbness and tingling in the extremities and weakness in the leg(s).

GCSC July2018-Back To Basics: SVF & PRP In Management Of Degenerative Disc Disease

Diagnosis begins with taking a full history by the medical provider. This should include previous surgeries, other conditions (like diabetes), family history, habits like alcohol and tobacco consumption and medication.  Once the practitioner has a good understanding of the characteristics of the pain, including timing, severity, radiation etc. and thorough history, (s)he can recommend a treatment plan. Imaging like X-rays, CT scan or MRI may be required to decipher the regional pathology.  Typically, treatment consists of medications such as aspirin NSAID to help with inflammation and pain.  Stronger pain relievers are prescribed for more serious or intense iterations of the condition.  Steroid shots or physical therapy may be required to help correct posture, ease symptoms and increase the range of motion.  If other treatments prove ineffective, the option of surgery may provide some relief at a cost.  Surgery options range from a laminectomy (removal of the arch of the vertebra) to removal of the injured disc or a portion of. In the removal of the disk, the adjacent vertebrae may be fused together, or a substitute artificial facsimile may be inserted.  In all of these cases, the result may be a large financial responsibility for the patient, lengthy recovery times, and a fair amount of post-surgical pain; and chronic post-surgical pain may ensue unabated. 

PRP and ADSC’s Provide a Better Management Alternative

Recently, research studies have focused on the use of adult stem cells for disorders such as degenerative disc disease. Stromal Vascular Fraction (SVF), a multipotent cellular soup of beneficial agents such as adipose-derived stem cells and growth factors, can be easily obtained during a painless outpatient procedure.  Platelet-rich plasma, obtained from the person’s own blood, contains a number of concentrated, wound healing factors and helps the stem cells promote and enhance tissue regeneration.  Both of these therapy modalities have great beneficial potential in the field of regenerative medicine and offer a better option in terms of outcome and management to patients.  The best part of these revolutionary therapies is that they are minimally invasive.  In both cases, these FDA guideline-compliant procedures are done on an outpatient basis. Adipose tissue has been identified as the safest and most cost-effective method of obtaining stem cells.  We utilize autologous adipose tissue, using the patient’s own body fat as the source, minimizing the chances of rejection to zero.  These ADSC’s (adipose-derived stem cells) are multi-potential in that they have the innate ability to differentiate into a wide variety of tissue types including bone, cartilage, muscle tissue, connective tissue, neural tissue, ­­and fat.  PRP and stem cells both contain large numbers of growth factors and signaling molecules, which serve to recruit other cell types to repair damage in affected tissues.  ASDC’s help to promote the growth of new blood vessels and serve as anti-inflammatory agents.

With this in mind, it seems that stem cells isolated from adipose tissue offer an exciting opportunity for providers and patients alike, especially in the case of degenerative disc disease.  SVF injected directly into the affected disc, or facet joints may reduce inflammation and aid in healing.  PRP obtained similarly from an autologous source adds its own store of growth factors and fibrin, thereby strengthening the therapeutic benefits of stem cells for degenerative disc disease.  Patients studied in experimental research report improvement mobility and increased range-of-motion with less pain, both two and six months following injections.  A significant decrease in pain scores was also reported nearly across the board, both in the period from baseline to 2 months post-procedure, and later 2-6-months following PRP/ASDC injection.  In both areas, the results were statistically significant with a positive relationship between therapy and symptom alleviation.  No severe adverse events were reported during the studies, including the required 12-month follow-up period. 

Future Directions

Until recently, patients affected by degenerative disc disorder had few options outside of symptom management through medication and surgical intervention.  Surgery requires not only extensive recovery time but understanding that serious complications can occur.  Nerve root damage, incontinence, infection, and spinal leakage may all be real consequences of spinal surgery, not to mention the risks inherent to general anesthesia.  Yet stem cell therapy has developed a strong following in the regenerative medicine community.  Adipose-derived stem cells as part of SVF is a feasible candidate for degenerative conditions of all kinds.  SVF requires no culture expansion and is easy to collect during an outpatient visit.  SVF can be isolated in 90 minutes; is affordable and cost-effective.  These cells can then be injected directly into the affected site(s) using a minimally-invasive technique with little or no recovery period.

At the Gulf Coast Stem Cell and Regenerative Medicine Center, we are actively engaged in research programs, managing a wide range of varied disorders, including orthopedic, degenerative, neurological and autoimmune. For more information about the diseases and disorders that we currently address and study, please call (866) 885-4823 or visit our website.

Research Article: https://bit.ly/2N36yL6

Download: GCSC July 2018 Back to Basics: SVF and PRP in the Management of Degenerative Disc Disease