Biologic Treatment for Chronic Low Back Pain: will this be the answer?

For the last 50 years, spine fusions have increasingly been used to treat chronic low back pain. Originally, spinal fusion surgery was indicated for cases of spinal deformity, spinal instability or reconstruction of the spine after infections, such as tuberculosis, or after tumor excision.

Spine Fusion with Instrumentation

With the advent of newer metal alloys, technology improved and many companies developed spinal devices  and the indications controversially expanded to include chronic low back pain. As a result, more and more surgeons began using spine fusion as a primary treatment for chronic low back pain.

Spine fusion surgery requires a wide surgical dissection that is difficult for many people to recover from. It  also has many potential serious complications. As a result of overuse and the many potential complications, most people in the United States have now heard about someone who has had a poor outcome from spine fusion surgery.

Today, minimally invasive spine fusion techniques have decreased the large surgical exposures required for spine fusions and markedly decreased the blood loss that occurs. However, one of the most common conditions that follows spinal fusion is what is termed, adjacent segment disease (aka, transitional segment disease). This is caused by transfer of stress to the vertebral disc directly above or below a spine fusion. This problem is not resolved with minimally invasive spine fusions techniques.

There has also been confusion with the term, minimally invasive spine surgery. Some spine surgeons use the term to describe less invasive spine fusion techniques. Others use it to describe non-fusion spine surgery performed through tiny incisions. A patient may not be able to distinguish the difference between these types of minimally invasive surgeons.

There are are also many web sites that promote laser spine surgery and endoscopic spine surgery. Most of these practices offer non-fusion alternatives to spine fusion for chronic low back pain.

Regardless of the treatment option selected, it is fortunate that we now have many treatment options to consider for the treatment of chronic low back pain in addition to spine fusion.

There is also considerable research into a more biologic approach to chronic low back pain (CLBP). These interventions use what are termed, biologics, and are used to treat degenerating discs. There have been many recent articles reporting the positive effects of stem cells, PRP, OP-1, rh-BMP2 and even the cholesterol lowering drug, simvistatin in the treatment of these discs.

Adult Stem Cell

In the United States, there have been two orthopedic centers that have specialized in the clinical applications of adult, not embryonic, stem cells: Centeno-Schultz Clinic, Broomfield, CO, and Celling Treatment Centers, Austin, Texas. These clinics currently employ innovative stem cell protocols for chronic musculoskeletal conditions including disorders of the spine.

Celling Treatment Centers combines minimally invasive and endoscopic laser spine procedures with stem cell treatments in order to treat the source of pain and provide a biologic so that the body may heal itself.

It will likely take many years to determine if any of the other biologics will be clinically effective. However, it appears that the number of spine fusions for the primary treatment of CLBP will continue to decrease as minimally invasive non-fusion alternatives and biologic treatments become more widespread.


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