gms | German Medical Science

Objective: Morphological restoration of degenerated intervertebral discs through the use of autologous disc chondrocyte transplantation (ADCT) represents a strategy that offers a potential to accentuate disc metabolism that will achieve mechanic function. This could be demonstrate in a precinical animal study and was translated into the clinical EuroDisc study. We present a clinical series of 109 ADCT cases that were enrolled from January 2000 to March 2013 in a single institution. The clinical goal was to provide long-term pain relief, prevent adjacent segment disease and reduce recurrent disc herniation.

Method: Since 2000 we observe 168 patients with single level intervertebral disc herniation with acute neurological symptoms or after conservative treatment failure. Operative procedure was done as a minimal invasive open sequestrectomy done by an experienced neurosurgeon. Cells are transplanted approximately 12 weeks following sequestrectomy to assure that the annulus has healed and will contain the cells. Therefore a single puncture was used. Oswestry low back pain disability questionnaire (OPDQ), Prolo and VAS scores were used for the evaluation. Disc height and water content were assessed by MRI. Demographic data, neurological status and BMI were collected from the patients 6, 12 and 24 months postoperatively.

Results: 109 patients received autologous disc chondrozyte transplantation. The mean age of the patients was 34.6 years; the mean BMI 23.9. Significant improvement in OPDQ total sum score persisted through the two-year assessment. The ADCT treated group showed a substantially higher normalization of water content in the MRI as the control group; 41% normal fluid content compared with only 25% normal content in the control group. Reherniation rate was reduced by 52%. No neurological or inflammatory complications were reported.

Conclusions: Clinical durability as well as pain and disability gains of these ADCT patients was defined under strict regimen of inclusion/exclusion criteria for this minimally-invasive percutaneous disc repair. Patients treated with this regenerative procedure using autologous disc chondrocyte transplantation to reduce and restore degeneration in affected intervertebral discs had a better clinical and morphological outcome. Changing EU-ATMP regulation, missing reimbursement strategies and low economic support could be identified as pitfalls and draw back of this translational clinical project.