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Biological disc repair

The problem
Despite a successful operation of a disc herniation 70% of patients will develop back pain and about 10% of them  must be operated again. Often the removal of the sick intervertebral disc and the implantation of an artificial disc or fusion is required due to an advanced degeneration. The cause of the progressive degeneration of the disc, is the loss of tissue as a result of the disc herniation and the subsequent operation. The disc alone is unable to rebuild this lost tissue. As a result of further stress the "residual"disc losing increasingly agility and suppleness. She will become dry and brittle and transforms from a grape to a raisin. In the MRI it is displayed as  a so-called "black disc". Then, later, it can lead to spinal instabilities and deformations. This process is associated with pain.

Disc degeneration  over the course of about 4 years
Fig.1.  Onset degeneration. The disc has lost of water and became grey. This means also loss of elasticity.
Fig. 2. The degeneration has progressed. There are tears in the annulus and disc extrusion is possible. Fig. 3. Further degeneration with loss of height.
Fig.1. 4 The degeneration has spread to the adjacent intervertebral discs due to a multi factorial impact and stress.

The possible solution
There are 2 cell-based approaches.
On the one hand the removed herniated disc can be processed, i.e. disc cells are cultured and can proliferate. This leads to healthy disc cells in a high number. These cells will be reinjected into the disc 3 months after the 1st operation. The cells will proliferate in the intervertebral disc,  produce proteoglycans and increase water content which will improve function. Several studies demonstrated effectiveness of this procedure.
On the other hand, every person has stem cells, which are not are not differentiated  in any form  and can be programmed by  the surrounding tissue. These stem cells have a renewal and repair function and can replace defective cells. They provide that injuries are healing, and that an organ or cell associations restore original function. These properties of adult stem cells can also be used for the regeneration of disc tissue. In contrast to embryonic stem cells are not ethical concerns.
There are various sources of adult stem cells. Most common source is the bone marrow. However, there are the cells not in a sufficient high numbers and must be increased in the laboratory. While adult stem cells are difficult to proliferate, only few cells are available for treatment. Adult stem cells are in higher number in fat tissue and can be easily obtained by liposuction. Through a special process, they are isolated from adipose tissue and are available for treatment. Scientific research shows that  adipose tissue derived stem cells have the potential to differentiate towards chondrocytes, i.e. disc cells and to produce so-called proteoglycans.  These are proteins that are responsible for the water content and function as well as the elasticity of the intervertebral disc. Thus could from adipose tissue obtained and in the nucleus pulposus transplanted stem cells prevent further disc degradation.  To what extent this process individual works can be judged not sure since there are only a few reports on the application of the procedure. It seems however, that there are positive effects.  So, this is a brand new procedure, which is applied in an individual therapy attempt.