Comparison of Bone Marrow Concentrate, Non-Operative Care and Fusion for Discogenic Back Pain

Abstract

Introduction The United States direct and indirect cost of discogenic back pain exceeds 100 billion dollars annually [1,2]. Non-operative treatments include weight loss, exercise, heat, ice, NSAIDs, chiropractic, physical therapy, acupuncture, oral steroids, steroid injections, and opiates [3,4]. The use of opiates to treat chronic low back pain is a major contributor to the current opioid crisis [5]. Surgical options for discogenic back pain are generally fusion. [6,7]. The lumbar fusion treatment for discogenic back pain has been evaluated by Phillips, et al. They published a systematic review of 26 studies comparing spinal fusion versus conservative care as well as studies comparing different fusion techniques for discogenic back pain [8]. The use of biologics to treat disc abnormalities is a nonsurgical option which can potentially bridge the gap between traditional non-surgical treatments for degenerative disc abnormalities and fusion surgery. There is mounting evidence to support the use of biologic and cellbased therapy for chronic discogenic low back pain. The authors of this paper have published one, two, three and five-year follow-up from a study assessing the safety and efficacy of bone marrow concentrate [BMC] cells as an alternative to surgery for discogenic back pain at one or two levels [9,10,11,38]. The authors have also published the results of treating multi-level discogenic back pain with BMC [35].