spinal fusion questions

Stem cells for spinal surgery

In this article we will explore one study on the use of stem cells in spinal surgery. At the end we will provide resources for utilizing stem cells as a non-surgical injection therapy

In the first study, doctors from the University of Rome looked to enhance healing during spinal surgery.

Here is what they wrote:

(Stem Cells) have shown therapeutic applications in different medical fields and could represent a successful treatment of degenerative disc disease (DDD). Several studies have demonstrated stem cells efficacy in spine surgery

Twenty-two consecutive patients, who suffered of spine DDD, were submitted: in 11 cases the MSCs were harvested from red bone marrow, 11 from fat tissue.

All the posterolateral fusions and stem cell implantations showed at three months a complete bone bridge, stable at follow-up.

There are several questions that need to be answered but MCSs look promising in lumbar spine surgery, both to block the aging of the disc both to accelerate the fusion processes in arthrodesis.1

Failed back surgery – New research in the medical journal Spine suggests that patients who have a case review by a team of spinal pain specialists will likely not get a spinal fusion surgery.

In the study the researchers representing Virginia Mason Medical Center, Massachusetts General Hospital, and the  University of Washington implemented a multidisciplinary conference involving physiatrists, anesthesiologists, pain specialists, neurosurgeons, orthopaedic spine surgeons, physical therapists, and nursing staff.

Over ten months, they examined patients being considered for spinal fusion or who had a complex history of prior spinal surgery. They discussed the patients’ cases and when they decided on surgery and the type of surgery they chose to see if these were good recommendation.

This is what the research suggested:

“Isolated surgical decision making may result in suboptimal treatment recommendations. Multidisciplinary conferences can reduce the utilization of lumbar spinal fusion, possibly resulting in more appropriate use of surgical interventions with better candidate selection while providing patients with more diverse non-operative treatment options.”2

In other research doctors examined Pseudarthrosis (the non-union or non-healing of bones) following fusion for degenerative lumbar spine pathologies.

To a doctor who sees many failed back surgery patients, it is not surprising that the researchers said  pseudarthrosis remains a substantial problem. Current data shows that patients who develop a pseudarthrosis have suboptimal outcomes. (Some would call suboptimal, failure, or catastrophic failure of the spinal fusion).

The somber news for patients with a non-healing spinal fusion is that these researchers concluded after an evaluation of the surgical approaches to revision surgery to fix this problem: “All surgical approaches examined for treatment of lumbar pseudarthrosis resulted in only poor to modest improvement in (disability improvement scoring).”3

1 Piccirilli M, Delfinis CP, Santoro A, Salvati M. Mesenchymal stem cells in lumbar spine surgery: a single institution experience about red bone marrow and fat tissue derived MSCs. J Neurosurg Sci. 2017 Apr;61(2):124-133. doi: 10.23736/S0390-5616.16.03266-X. Epub 2015 Jun 17. [Pubmed]

2Yanamadala V, Kim Y, Buchlak QD, Wright AK, Babington J, Friedman A, Mecklenburg RS, Farrokhi F, Leveque JC, Sethi RK. Multidisciplinary Evaluation Leads to the Decreased Utilization of Lumbar Spine Fusion: An Observational Cohort Pilot Study. Spine (Phila Pa 1976). 2017 Jan 6. [Pubmed]

3 Zaina F, Tomkins-Lane C, Carragee E, Negrini S. Surgical versus non-surgical treatment for lumbar spinal stenosis. Cochrane Database Syst Rev. 2016 Jan 29;(1):CD010264. doi: 10.1002/14651858.CD010264.pub2. [Pubmed]