Vadalà Gianluca, Ambrosio Luca, Russo Fabrizio, Papalia Rocco, Denaro Vincenzo
Department of Orthopaedic and Trauma Surgery, Campus Bio-Medico University of Rome, Rome, Italy.
Int J Spine Surg. 2021 Apr;15(s1):40-53. doi: 10.14444/8054. Epub 2021 Apr 21.
Low back pain (LPB) is the main cause of disability worldwide with enormous socioeconomic burdens. A major cause of LBP is intervertebral disc degeneration (IDD): a chronic, progressive process associated with exhaustion of the resident cell population, tissue inflammation, degradation of the extracellular matrix and dehydration of the nucleus pulposus. Eventually, IDD may lead to serious sequelae including chronic LBP, disc herniation, segmental instability, and spinal stenosis, which may require invasive surgical interventions. However, no treatment is actually able to directly tackle IDD and hamper the degenerative process. In the last decade, the intradiscal injection of stem cells is raising as a promising approach to regenerate the intervertebral disc. This review aims to describe the rationale behind a regenerative stem cell therapy for IDD as well as the effect of stem cells following their implantation in the disc environment according to preclinical studies. Furthermore, actual clinical evidence and ongoing trials will be discussed, taking into account the future perspective and current limitations of this cutting-edge therapy.
A literature analysis was performed for this narrative review. A database search of PubMed, Scopus and ClinicalTrials.gov was conducted using "stem cells" combined with "intervertebral disc", "degeneration" and "regeneration" without exclusion based on publication date. Articles were firstly screened on a title-abstract basis and, subsequently, full-text were reviewed. Both preclinical and clinical studies have been included.
The database search yielded recent publications from which the narrative review was completed.
Based on available evidence, intradiscal stem cell therapy has provided encouraging results in terms of regenerative effects and reduction of LBP. However, multicenter, prospective randomized trials are needed in order confirm the safety, efficacy and applicability of such a promising treatment.
下腰痛（LPB）是全球致残的主要原因，带来了巨大的社会经济负担。下腰痛的一个主要原因是椎间盘退变（IDD）：这是一个慢性、渐进性的过程，与驻留细胞群耗竭、组织炎症、细胞外基质降解以及髓核脱水有关。最终，IDD可能导致严重的后遗症，包括慢性下腰痛、椎间盘突出、节段性不稳定和椎管狭窄，可能需要进行侵入性手术干预。然而，实际上没有任何治疗方法能够直接解决IDD并阻止退变过程。在过去十年中，椎间盘内注射干细胞作为一种有前景的椎间盘再生方法正在兴起。本综述旨在根据临床前研究描述针对IDD的再生干细胞治疗背后的原理以及干细胞植入椎间盘环境后的效果。此外，将讨论实际的临床证据和正在进行的试验，同时考虑这种前沿治疗的未来前景和当前局限性。
进行了文献分析以撰写本叙述性综述。在PubMed、Scopus和ClinicalTrials.gov数据库中进行搜索，使用“干细胞”与“椎间盘”、“退变”和“再生”相结合，不基于发表日期进行排除。文章首先根据标题摘要进行筛选，随后进行全文审查。纳入了临床前和临床研究。
数据库搜索产生了近期的出版物，据此完成了叙述性综述。
根据现有证据，椎间盘内干细胞治疗在再生效果和减轻下腰痛方面取得了令人鼓舞的结果。然而，需要进行多中心、前瞻性随机试验以确认这种有前景的治疗方法的安全性、有效性和适用性。
