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Cell-Based Therapies for Lumbar Discogenic Low Back Pain

Systematic Review and Single-Arm Meta-analysis

Wu, Tao, MD; Song, Hai-xin, MD; Dong, Yan, MD; Li, Jian-hua, MD

doi: 10.1097/BRS.0000000000001549
LITERATURE REVIEW
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Study Design. A systematic review and single-arm meta-analysis of clinical trials.

Objective. To assess the efficacy of mesenchymal stem cells or chondrocyte in patients with discogenic low back pain.

Summary of Background Data. There is no previous review evaluated the efficacy of mesenchymal stem cell or chondrocyte therapy in adults with discogenic low back pain.

Methods. A comprehensive literature search was conducted on PubMed, Ovid MEDLINE, Ovid EMBASE, EBSCO, and Web of Science from database inception through on September 10th, 2015. We included clinical trials that evaluated stem cells or chondrocyte-based therapy in patients with discogenic back pain. The primary outcomes of interest were pain score and Oswestry Disability Index (ODI). We performed random-effects model meta-analyses to assess net changes in the same outcome variables. Heterogeneity between studies was estimated by I2 statistic.

Results. The initial search identified 1393 articles, of which 6 studies were eligible for this review. The pooled mean difference in pain score from baseline to follow-up points was 44.2 points decreased (95% CI: −61.8 to −26.5, P < 0.001, I2 = 99.4%). Meanwhile, the pooled mean difference in ODI from baseline to follow-up points was 32.2 points decreased (95% CI: −41.6 to −22.9, P < 0.001, I2 = 99.5%). No related adverse effects were reported by the included studies.

Conclusion. Cell-based therapy is for patients who have discogenic low back pain associated with improved pain relief and ODI. More stringently designed randomized double-blind clinical trials with appropriately determined sample sizes will be needed to confirm its clinical efficacy and safety.

Level of Evidence: 4

Department of Rehabilitation Medicine, Sir Run Run Shaw Hospital, College of Medicine, Zhejiang University, Zhejiang, China

Department of Rehabilitation Medicine, Hangzhou Hospital of Zhejiang CAPF, Zhejiang, China.

Address correspondence and reprint requests to Jian-hua Li, MD, Department of Rehabilitation Medicine, Sir Run Run Shaw Hospital, College of Medicine, Zhejiang University, 3, East Qin Chun Road, Hangzhou, Zhejiang 310016, China; E-mail: zjdxsyfkfk@126.com

Received 9 November, 2015

Revised 22 January, 2016

Accepted 1 February, 2016

The manuscript submitted does not contain information about medical device(s)/drug(s).

No funds were received in support of this work.

No relevant financial activities outside the submitted work.

T.W. and H.S. contributed equally to this work.

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