19 November 2009

Injection Could Help Regrow Spine, Reduce Back Pain


POSTED: 6:21 pm MST November 18, 2009

About 80 percent of Americans will experience low back pain at some point in their lives.

It's the second most common reason people visit their doctors. Often, these patients have torn or ruptured discs that cause excruciating pain. But there's a new option on the horizon that could regrow healthy discs in the spine without surgery.

Rebecca Tirs spends most days curled up in bed with her pal, Jenny Bee. But this isn't how life has always been for these two.

Ten years ago, Tirs was an active 28-year-old. But then she was in a rollover car accident, where she tore two discs in her low back.

"I had a mild traumatic brain injury. I had a fractured pelvis. I had fractured scapula, fractured ribs," she said.

Tirs can barely walk. She had to quit work and give up all her favorite activities.

"It was just constant, deep down to the bone, severe pain," Tirs said. "I cried all the time."

Dr. Michael DePalma is working on a new way to heal injured backs. As part of a clinical trial, he injects growth factors, found naturally in the body, into damaged discs.

"The growth factors are that, they stimulate growth of certain tissue," said DePalma, the medical director at the VCU Spine Center in Richmond, Va.

The injection includes a growth factor called OP1, a key ingredient in the development of bone and tissue. In animals, the shot helped damaged discs grow back. Doctors say in humans, it could mean no surgery, no damage to surrounding tissue and little downtime.

"This sort of treatment may find its role in treating the disc before they get to a point beyond which only surgery is going to help," DePalma said.

Tirs doesn't know if she received a placebo or the real injection, but she noticed a slight improvement in her pain level.

"Instead of maybe an eight or a nine, I was a seven," she said.

She said every bit helps -- if it gets her one step closer to her old, vibrant self.

Researchers are still working to see if one injection is enough to ease the pain. Eligible patients have suffered lower back pain for three to six months despite physical therapy and medication.

BACKGROUND: Intervertebral discs, which form the cushions between the vertebrae of the spine and make up about a third of the spine's height, degenerate earlier than any other connective tissue in the body. When a disc degenerates, it loses height and affects the mechanics of the entire spine, possibly negatively affecting surrounding muscles and ligaments.

A major cause of back pain, research shows pain from disc degeneration affects 12 to 35 percent of the Western world, according to the journal Arthritis Research & Therapy.

"Back pain is common, and the most common source of back pain is a disc," said Michael DePalma, M.D., an interventional spine specialists at VCU Spine Center in Richmond, Va..

About 10 percent of back pain sufferers become chronically disabled. When a disc ruptures or bulges to press on a nearby nerve root, the injury is called a herniation. Experts believe some degeneration must take place before a disc herniates.

CAUSES: Aging and injury are the most common causes of disc degeneration. These factors lead to a loss of hydration in the material that makes up a disc, which ultimately leads to the loss of height. This loss of height eventually causes pressure on the nerve roots in the spine, resulting in pain.

New research suggests genes may play a larger role in back pain than once thought. A research team at the University of Alberta recently discovered eight genes linked to degeneration of discs in the lumbar region of the spine. The discovery came a year after the same team demonstrated that disc degeneration is affected in a large way by genetics.

REGENERATING DAMAGED DISCS: While medications, physical therapy and surgery can help some back patients, researchers are exploring new options for treating discs with the body's own resources. Studies examining treatments like gene therapy, stem cell therapy, cellular scaffolds and growth factor injections are underway in animals, and some in humans.

Growth factors are molecules that bind to cell membranes and activate the growth of new cells. A single injection of the growth factor OP-1 has been shown in animals to both increase the height of a disc and reduce pain, without damaging surrounding tissue. The first trial examining the treatment in humans is underway.

"This sort of treatment may find its role in treating the disc before they get to a point beyond which surgery is going to help," Dr. DePalma said.


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