Clinical and radiological resolution of multilevel lumbar disc extrusion and spinal stenosis following combinatorial intradiscal bone marrow aspirate concentrate and epidural platelet lysate: a longitudinal case study

Abstract

Lumbar disc degeneration and spinal stenosis are the leading causes of chronic low back pain and radiculopathy, often resulting in significant functional impairment and the reduced quality of life. Conventional treatments, surgical interventions add genetic predisposition are the confounding variable outcomes. Orthobiologics like bone marrow aspirate concentrate (BMAC), with their inherent mesenchymal stem cells and growth factors, have been promising as a clinical and therapeutic minimally invasive approach in the management of lumbar disc degeneration and spinal stenosis. A 55-year-old male presented with chronic low back pain radiating to the right lower limb, and was refractory to conservative management. Baseline showed moderate pain (NPRS 6/10), mild spinal listing, Grade II tenderness (L3-S1), dermatomal sensory deficits (L3-S1), mild motor weakness (L5-S1) and positive straight leg raise (SLR) and slump tests. The patient underwent fluoroscopy-guided intradiscal BMAC injection at L4-L5 and L5-S1 levels. At six months follow-up, significant improvement was observed, with pain reduced to NPRS 1/10, minimal spinal listing, and decreased add with grade I at L5-S1. Neurological recovery included normalization of motor strength, minimal residual sensory deficit, and negative SLR and slump tests. The present case demonstrates that intradiscal BMAC therapy can result in significant symptomatic, functional and neurological improvement in lumbar disc degeneration with radiculopathy. The study advocates for regenerative therapy with minimal invasive approach and as an alternative to the surgery, however larger controlled studies with long-term follow-up are warranted.