Treating Discogenic Back Pain with Bone Marrow Concentrate is Superior to Lumbar Disc Replacement at Two-Year Follow-up

Introduction Direct and indirect costs of discogenic back pain in the United States 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 [3,4,5]. The use of opiates to treat chronic low back pain is a major contributor to the current opioid crisis [3,4]. Surgical options for one or two levels of discogenic back pain are fusion or lumbar artificial disc replacement (LADR) [22,23]. LADR was developed to potentially improve on the clinical results of lumbar fusion for treating discogenic back pain and reduce the development of adjacent level disc pathology resulting in repeat fusion surgery [12,13,14]. Numerous prospective randomized studies have reported superior but non-significant improvements in VAS and Oswestry Disability Index (ODI) comparing LADR to fusion [15,16,17,19,20,24,25,26,28]. The use of biologics to treat disc abnormalities is a possible non-surgical option which potentially can bridge the gap between traditional non-surgical treatments for discogenic back pain and surgery. There is mounting evidence to support the use of biologic and cell-based therapy for chronic discogenic low back pain.