886 - Comparison of Mesenchymal Stem Cell Injection Therapy and Thermal Annular Procedures for the Treatment of Discogenic Back Pain: A Systematic Review with Pooled Analysis

Objectives: Discogenic back pain is a common symptom that may arise from degenerative disc disease, herniation, annular tears, trauma, or similar maladies. For some patients, conservative management such as physical therapy and pharmaceuticals fails to provide adequate relief. We hypothesize that minimally invasive techniques such as thermal annular procedures or mesenchymal stem cell injections may prove effective in such cases, thereby avoiding more invasive procedures such as discectomy, fusion, or disc replacement procedures. This study aims to evaluate and compare the effectiveness of mesenchymal stem cell injection therapy (MSC), intradiscal biacuplasty (IDB), intradiscal electrothermal therapy (IDET) and radiofrequency annuloplasty (RA) for the treatment of discogenic back pain.

Design: A systematic review was performed following PRISMA 2020 guidelines, including broad searches of four pertinent databases. A total of 2238 results were retrieved, of which 13 were found to meet all inclusion criteria. Pooled analysis was performed, examining pain reduction using the visual analogue scale (VAS) or numeric rating scale (NRS) scores at baseline and at 12 months post-intervention. Qualitative results were synthesized in a discussion of the most important findings of the included studies.

Results: Pooling results from the included studies, effect sizes calculated based on the change in pain score from baseline to 12 month follow up were as follows:

IDB: -1.067, 95% CI: [-1.626 to -0.508], p < 0.0005, n=32/25

IDET: -2.845, 95% CI: [-4.437, -1.253], p < 0.0005, n=96/96

RA: -1.586, 95% CI: [-2.331, -0.841], p < 0.0005, n=106/96

MSC: -5.850, 95% CI: [-8.721, -2.979], p < 0.0005, n=113/108

Conclusions: All four interventions showed significant pain reduction, with mesenchymal stem cell injection therapy demonstrating the largest. This supports our hypothesis that minimally invasive interventions provide meaningful relief in discogenic back pain and suggests that mesenchymal stem cell injection therapy may be the most effective minimally invasive intervention for discogenic pain.