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自体骨髓抽吸浓缩物疗法改善下腰痛患者的脊柱退行性关节病。

Autologous BMAC Therapy Improves Spinal Degenerative Joint Disease in Lower Back Pain Patients.

作者信息

El-Kadiry Abed El-Hakim, Lumbao Carlos, Rafei Moutih, Shammaa Riam

机构信息

Laboratory of Thrombosis and Hemostasis, Research Center, Montreal Heart Institute, Montreal, QC, Canada.

Department of Biomedical Sciences, Université de Montréal, Montreal, QC, Canada.

出版信息

Front Med (Lausanne). 2021 Mar 18;8:622573. doi: 10.3389/fmed.2021.622573. eCollection 2021.

Abstract

Spinal degenerative joint disease (DJD) is associated with lower back pain (LBP) arising from the degeneration of intervertebral discs (IVD), facet joints, intertransversarii muscles, and interspinous ligaments among other anatomical structures. To circumvent the socioeconomic burdens and often-problematic surgical options imposed by DJD therapy, cell-based biologic modalities like bone marrow aspirate concentrate (BMAC) have been investigated in pre-clinical and clinical settings, mostly for IVD degeneration (IDD), with encouraging outcomes. In this study, we evaluated the differences in therapeutic benefits of BMAC between IVD- and facet joint-originating chronic LBP. Eighteen patients diagnosed with chronic LBP met the selection criteria. Following discography and provocation testing, 13 patients tested positive and were assigned into IDD-associated LBP (1st arm), while the remaining 5 tested negative and were assigned into facetogenic LBP (2nd arm). Autologous BMAC was injected intradiscally in the 1st arm, while the 2nd arm received posterior spinal chain injections. No procedure-related serious events ensued. Clinical improvement was evaluated over 12 months based on pain and functionality questionnaires (VAS, BPI, RAND-36), opioid use, and changes in disc parameters assessed by magnetic resonance imaging (MRI). Ameliorated VAS and BPI scores differed significantly between both arms in favor of IDD patients who also took significantly less opioids. Average RAND-36 scores showed no significant difference between groups albeit a trend suggesting improvement was observed in IDD patients. MRI scans conducted on IDD patients demonstrated marked elevation in disc height and spinal canal space size without worsening disc quality. Overall, this is the first study investigating the potency of BMAC as an IDD treatment in Canada and the first globally for addressing facetogenic pain using cellular therapy.

摘要

脊柱退行性关节病(DJD)与下背部疼痛(LBP)相关,后者源于椎间盘(IVD)、小关节、横突间肌和棘间韧带等其他解剖结构的退变。为了规避DJD治疗带来的社会经济负担以及通常存在问题的手术选择,诸如骨髓抽吸浓缩物(BMAC)等基于细胞的生物治疗方法已在临床前和临床环境中进行了研究,主要用于IVD退变(IDD),取得了令人鼓舞的结果。在本研究中,我们评估了BMAC对源于IVD和小关节的慢性LBP的治疗效果差异。18例被诊断为慢性LBP的患者符合入选标准。在椎间盘造影和激发试验后,13例检测呈阳性的患者被分配到与IDD相关的LBP组(第一组),而其余5例检测呈阴性的患者被分配到小关节源性LBP组(第二组)。第一组患者接受椎间盘内自体BMAC注射,而第二组接受脊柱后链注射。未发生与操作相关的严重事件。基于疼痛和功能问卷(VAS、BPI、RAND - 36)、阿片类药物使用情况以及通过磁共振成像(MRI)评估的椎间盘参数变化,在12个月内对临床改善情况进行了评估。两组之间VAS和BPI评分改善情况存在显著差异,IDD患者更占优势,且IDD患者服用的阿片类药物也显著更少。平均RAND - 36评分在两组之间无显著差异,尽管有趋势表明IDD患者有所改善。对IDD患者进行的MRI扫描显示椎间盘高度和椎管空间大小显著增加,且椎间盘质量未恶化。总体而言,这是加拿大第一项研究BMAC作为IDD治疗方法效力的研究,也是全球第一项使用细胞疗法解决小关节源性疼痛的研究。

https://cdn.ncbi.nlm.nih.gov/pmc/blobs/a168/8012529/9e94310e1165/fmed-08-622573-g0007.jpg

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