Oehme David, Goldschlager Tony, Rosenfeld Jeffrey V, Ghosh Peter, Jenkin Graham
The Ritchie Centre, MIM-PHI Institute of Medical Research, Monash University Clayton Victoria, PO Box 6178, Clayton, VIC, 3141, Australia,
Neurosurg Rev. 2015 Jul;38(3):429-45. doi: 10.1007/s10143-015-0621-7. Epub 2015 Mar 7.
Degenerative conditions of the lumbar spine are extremely common. Ninety percent of people over the age of 60 years have degenerative change on imaging; however, only a small minority of people will require spine surgery (Hicks et al. Spine (Phila Pa 1976) 34(12):1301-1306, 2009). This minority, however, constitutes a core element of spinal surgery practice. Whilst the patient outcomes from spinal surgeries have improved in recent years, some patients will remain with pain and disability despite technically successful surgery. Advances in regenerative medicine and stem cell therapies, particularly the use of mesenchymal stem cells and allogeneic mesenchymal precursor cells, have led to numerous clinical trials utilising these cell-based therapies to treat degenerative spinal conditions. Through cartilage formation and disc regeneration, fusion enhancement or via modification of pain pathways, stem cells are well suited to enhance spinal surgery practice. This review will focus on the outcomes of lumbar spinal procedures and the role of stem cells in the treatment of degenerative lumbar conditions to enhance clinical practice. The current status of clinical trials utilising stem cell therapies will be discussed, providing clinicians with an overview of the various cell-based treatments likely to be available to patients in the near future.
腰椎退行性疾病极为常见。60岁以上的人群中，90%在影像学检查上有退行性改变；然而，只有一小部分人需要脊柱手术（希克斯等人，《脊柱》（费城，1976年），34(12):1301 - 1306，2009年）。然而，这一小部分人构成了脊柱外科手术实践的核心部分。尽管近年来脊柱手术的患者预后有所改善，但仍有一些患者尽管手术技术成功，却仍伴有疼痛和残疾。再生医学和干细胞疗法的进展，尤其是间充质干细胞和异体间充质前体细胞的应用，已引发了众多利用这些基于细胞的疗法治疗退行性脊柱疾病的临床试验。通过软骨形成、椎间盘再生、融合增强或通过改变疼痛通路，干细胞非常适合于改善脊柱外科手术实践。本综述将聚焦于腰椎手术的结果以及干细胞在治疗退行性腰椎疾病以改善临床实践中的作用。还将讨论利用干细胞疗法的临床试验的现状，为临床医生提供关于近期患者可能可用的各种基于细胞的治疗方法的概述。
