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

Study Design: This paper compares 2 published studies on the results of treating discogenic back pain with bone marrow concentrate (BMC) to a systematic review on the results of lumbar fusion (20 studies) and nonoperative care (6 studies) for the same diagnosis. Materials: 6 RCT papers comparing fusion to non-operative care met criteria. 12 RCT comparing fusion to fusion papers met criteria. 2 prospective non-randomized fusion papers met criteria. Fusion techniques included a combination of PLF, PLIF, TLIF, and ALIF. Results: The improvement of ODI in the 20 surgical studies from pre-treatment to follow-up averaged 36.7%, in the 6 non-surgical studies 17.5% and in the 2 BMC studies 64.7%. The improvement in VAS in the surgical studies was 47.1%, in the non-operative studies 20% and in the BMC studies 69%. Overall satisfaction was 65.5% in the surgical studies, 55.6% in the non-operative studies and 67% in the BMC studies. The BMC studies had significantly better improvements in ODI and VAS vs. the surgical or non-operative studies. The overall cost was significantly less with the BMC treatment ($5,000) compared to surgery ($50,000 to $75,000). Only 9 of the 172 (5.2%) BMC patients had surgery vs. 24 of 130 (18.4%) non-operative patients. The re-operation rate in the surgical studies was 11.7%. Conclusions: The use of bone marrow concentrate appears to be safe and efficacious. It may have advantages compared to surgery or non-operative care for the treatment of discogenic back pain.