A University of Manchester researcher has developed a treatment for lower back pain which uses the patient’s own stem cells, sparking hopes that it could replace the use of strong painkillers or surgery.

Low back pain (LBP) affects a large proportion of the adult population at some point in their lives and in many of these cases it is persistent, eventually leading to debilitating pain.

The majority of the cases of LBP are due to degeneration of the intervertebral disc (IVD), the soft tissue which separates the vertebrae in the spine and protects them from damage; it is the flexibility of this tissue that allows movement of the spine (bending, twisting etc).

The IVD is comprised of a central gel-like tissue (nucleus pulposus or NP), surrounded by a fibrous ring of tissue (annulus fibrosus or AF). Over time the NP becomes dry and fibrous and cannot support the weight of the body, which means the disc becomes damaged and painful and this is the source of the LBP in many people.

Currently, treatments address the symptoms - mainly pain - using a combination of painkillers, physiotherapy or surgery, removing tissue to relieve the pain or fusing the vertebrae above and below the painful disc level together to remove the pain, although this also stops movement at that disc level. None of these options is ideal as they only treat the symptoms, not the cause, and are of limited long-term success.

The treatment Dr Richardson is developing uses a cell-based tissue engineering approach to regenerate the IVD at the affected level. This is achieved through the combination of the patients’ own mesenchymal stem cells (MSCs) and a naturally occurring collagen gel that can be implanted through a minimally-invasive surgical technique.

MSCs are a population of progenitor cells found in the bone marrow of adults which can differentiate into many different cell types in the body, including bone, cartilage, fat and muscle cells. Dr Richardson found that for several reasons he could not use cells from the IVD itself and thus spent a number of years developing a method of producing NP cells from MSCs.

Dr Richardson explained: "Once we have extracted the bone marrow from the patient and have purified the MSCs, they will be grown in culture and our patented method of differentiation will be applied. They will then be embedded within a gel which can be implanted back into the patient through an arthroscope.

The treatment has massive implications for the future of LBP treatment - with substantial NHS cost savings as patients could be treated quickly and effectively without any need for extended hospitalisation. In addition, as both the cause and the symptoms are treated, only one treatment should be needed in a lifetime and there would be no need for continuous treatments with painkillers and physiotherapy.

The patient would therefore benefit and there are also implications for productivity in the workplace as a large number of work hours are lost every year due to sickness leave for low back pain. In the UK alone the combined figures for lost productivity and health-care costs due to low back pain run in the tens of millions of pounds a year and this will only increase as the population ages.