RESUMO
INTRODUCTION AND IMPORTANCE: Degeneration process occurs in humans after reaching their maximum potential. The degeneration process in the spine includes osteoporosis and degenerative disc disease, however, the conventional treatment causes many post-operative complications. Minimally invasive procedures have recently been carried out considering the same expected outcome and minimally injuring other tissues. Biological approaches using mesenchymal stem cells (MSCs) and secretomes are more promising for bone-related issues. We report a degenerative spine case managed with minimally invasive procedures combined with a biological approach. CASE PRESENTATION: An 83-year-old woman with a chief complaint of back pain after a fall, the physical examination found a painful area in the lower back accompanied by motor weakness in both legs, causing daily use of a wheelchair. Radiology examinations showed compression fracture, bulging disc, and osteoporosis. The patient underwent multiple minimally invasive procedures, namely vertebroplasty, MSCs implantation, PLDD, and secretome implantation. CLINICAL DISCUSSION: From 6 months of follow-up, it was found that the patient's posture getting better, the pain was reduced, and the results of the BMD examination were improved. The patient was able to carry out normal activities. This is due to vertebroplasty which strengthens the structure, PLDD which decompresses the disc, and implantation of MSCs and secretomes which improves the quality of the bone and surrounding tissue. CONCLUSION: The multi-minimally invasive procedure is potential for complex degenerative spine cases, particularly when combined with biological approaches using stem cells and secretomes in elderly, considering that complications from conventional treatment are quite common in elderly.
RESUMO
INTRODUCTION AND IMPORTANCE: Congenital scoliosis is abnormal vertebral column growth and development during embryogenesis. The most common type of congenital scoliosis is failure of growth which is called as hemivertebra. However, the recent surgical treatment of hemivertebra has several complications especially in young patient. The mesenchymal stem cells (MSCs) have been used to treat several bone problems including bone defect and may be have potential to treat the defect in hemiverterbra. We reported a hemivertebra treated by umbilical cord-derived MSCs (UC-MSCs). CASE PRESENTATION: A two-year-old boy presented with scoliosis deformity. The mother noticed the patient's deformity when he was 10th month of age as he learned to stand and progressed since then. There were no growth and development problems. On physical examination, the patient appeared to have scoliosis at lumbar level with bending to the right and asymmetry of waist fold with left shoulder depression. Based on X-ray and CT-Scan investigations, the patient was diagnosed with single fully segmented hemivertebra at 3rd lumbar level. 20 × 106 UC-MSCs were implanted into the bone defect of hemivertebra. CLINICAL DISCUSSION: At three-year follow-up, the X-ray and MRI investigations showed a decrease of Cobb angle and increase of hemivertebra ratio. These findings may be due to improvement of the bone defect, which is consistent with several studies that MSCs have abilities to promote bone formation by maintaining the osteoblast cells and improving vascularization. CONCLUSION: We found that MSCs therapy for hemivertebra represent a potential therapy to correct scoliosis curvature and prevent further curvature. Further clinical studies are required to investigate the efficacy of this therapy in hemivertebra.
