Chief of PM&R and Interventional Pain Management Kayal Orthopedic Center Franklin Lakesa, New Jersey, United States
Case Diagnosis: This is the case of a 42 year old male with a history of lower lumbar back pain who underwent a series of regenerative lumbar injections resulting in vertebral body endplate changes and discitis.
Case Description: The patient had a history of chronic low back pain refractory to conventional management. He was seen by a pain management specialist and received the diagnosis of discogenic pain as confirmed by history, physical exam, and MRI, for which he received conservative and interventional treatments with little change or improvement in symptoms. The patient then pursued alternative treatments including prolotherapy, PRP, and multiple stem cell injections to his lumbar spine. Following his most recent stem cell injection, he had temporary relief of his symptoms. However, about 8 weeks later, the low back pain returned with increased intensity.
Discussions: Follow up with another interventional pain physician yielded an additional MRI scan of the lumbar spine which showed evidence of L4 vertebral body end plate changes on T2 weighted images suggestive of a Schmorl’s node and discitis. Disc and bone biopsy were then done to determine cause. The biopsies were consistent with inflammatory changes in the bone and disc, however an infectious process was ruled out. Given the pain pattern, endplate changes, and other MRI imaging findings, as well as the lack of infection, the patient was subsequently referred for possible vertebral augmentation.
Conclusions: This case illustrates potential adverse effects of regenerative injections to the lumbar spine. While many regenerative techniques have shown promising results when more conservative treatments fail, potential side effects, including discitis and Schmorl’s node formation, should be considered.