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First Human Report of Relief of Lumbar and Cervical Discogenic and Arthritic Back Pain after Epidural and Facet Joint Mesenchymal Stem Cell Injection.

INTRODUCTION
Back pain causes tremendous patient suffering and high financial cost to the healthcare system. Mesenchymal Stem Cells (MSCs) have demonstrated the ability to enhance healing and reduce inflammation and pain without the deleterious side effects of corticosteroids and nonsteroidal anti-inflammatory drugs in numerous clinical series for peripheral joint arthritis. We hypothesized that translaminar MSC injection into the epidural space would provide effective treatment of disc arthritis without the burden of sedation and without the risks of disc space injection. We further hypothesized that MSC injection into the facet joints would effectively and safely treat facet joint-induced back pain. The combination of epidural and facet joint injection would then potentially treat the most recognized low back pain generators with virtually complete safety.


OBJECTIVE
We present the initial results for the first patient enrolled in a phase 1 clinical trial of the efficacy and safety of allogeneic MSCs when injected translaminarly and into the facet joints for the treatment of recalcitrant discogenic and arthritic back pain.


CASE REPORT
A 47-year-old male presented with complaints of 13-year-long chronic lower back pain resistant to conservative treatment. The decision was made to treat the patient with umbilical cord-derived MSCs. 87 million MSCs were infused intravenously. Simultaneously, 1 million cells were injected into each of the 8 lumbar epidural facet joints as well as 5 million cells into the lumbar epidural space. The patient had no adverse events or complications related to the treatment. Five days after treatment, most of his lumbar pain resolved along with complete resolution of the back spasms. He no longer needed to take acetaminophen or ibuprofen and had no difficulty sleeping without medications. The patient also reported his residual cervical radicular pain to be 98% resolved as a result of the injection.


CONCLUSION
We have demonstrated for the first time that MSC injection into the lumbar facet joints and epidural space results in significant improvement of lower back pain and additionally has the capability to improve symptoms in other spinal regions without engendering the risks associated with intradiscal injections or epidural use of corticosteroids.