Stem cell therapy for back pain.

The procedure

A needle is passed through the back into a worn lumbar disc, or into the small joints at the back of the spine. Most people who describe it were sedated or under a general anaesthetic.^[5] If your own cells are used they are taken from the back of the hip bone first, and patients describe that harvest as much easier than the spinal injection.^[5]

How many sessions

Every controlled trial used a single injection.^[1][6][2] Patients often describe many sites treated in one sitting, sometimes 17 to more than 50 injections across discs, joints and ligaments.^[5] Ask why each one is needed.

Recovery

Trial protocols restricted strenuous activity for two weeks and anti-inflammatory painkillers for six.^[4] Two in three patients who described the first weeks had a flare worse than their usual pain, mostly settling within one to three weeks, sometimes lasting two to three months.^[5]

When it works, and how long it lasts

Patients rarely report relief before six weeks, and most name three to six months.^[5] In the blinded trials, which followed people for one to three years, the cell groups never pulled clearly ahead of the dummy groups.^[1][2][4]

Who it suits, and who it doesn't

The largest trial enrolled people with one painful disc. It excluded severe degeneration, more than one painful disc, a trapped nerve, previous surgery on that disc, osteoporosis and a body mass index over 40.^[7] A higher body weight predicted failure in another trial.^[4]

Risks

More back pain for a few days is common, and almost as common after a saltwater injection.^[7] The serious risk is infection of the disc: two serious events among 136 published patients.^[8] Puncturing a disc also carries its own risk: over ten years, discs punctured once wore faster and herniated more often than untouched discs.^[9]

Will insurance pay for it?

Generally not. Pain specialists' guidance tells doctors to warn patients that most regenerative treatments are not covered.^[16][17]

Is PRP better?

No trial has compared them directly. Pooled figures favour PRP slightly at six months, but the best-controlled PRP disc trial was negative at a year.^[14][15] PRP vs stem cells

Will it fix a herniated or bulging disc?

No blinded trial has shown a change on the scan that went with a real benefit.^[1][2][3] Of patients who had a scan before and after, most found nothing had changed, even when they felt better.^[5]

What about the facet joints?

No randomised trial of cells in the facet joints has been published. The randomised facet trials tested PRP.^[13]

Questions to ask a clinic

1. What cell type is it, and how many cells go into each disc?
2. Does it go into the disc itself, or around it?
3. Will the needle be guided by X-ray or another scan?
4. Which of my diagnoses can this treat, and which can it not?
5. How many sites will you inject, and why each one?
6. What do you do to prevent a disc infection?
7. What can I not do afterwards, and for how long?