Joint Surgeons in Germany

Gelenk Klinik Orthopaedic Clinic

Street:
Alte Bundesstrasse 58

Town:
D-79194 Gundelfingen

Germany

fon: +49-761-55 77 58 28

fax: +49-761-58 974 650

clinic@joint-surgeon.com

Autologous Spinal Disc Cell Transplant (ADCT) - Regenerating Spinal Discs

Fact Sheet: Autologous Disc Chondrocyte Transplantation

  • Indication: Spinal disc degeneration after disc herniation and loss of spinal disc function leading to chronic back pain
  • Strategy: Extracorporeal regeneration of the body's own disc cells and reintroduction of the new cells by injection, into the weakened spinal disc
  • Inpatient treatment: 2 days
  • Outpatient treatment: 3 days
  • Recommended Outpatient Rehabilitation: 3 weeks
  • Earliest flight home: 2 days after surgery
  • Time between harvesting and transplant procedures: 12 weeks
  • Recommended flight home: 5 days after surgery
  • Time before showering: 2 days after surgery
  • Recommended time off work: 2 days
  • Time before suture removal: no sutures
  • Time before driving a car: 2 days

Autologous Intervertebral Disc Cell Transplantation - a new treatment to regenerate a degenerated spinal disc

How does it feel to have a degenerated spinal disc?

  • Pain in the lumbar (lower back) or sciatic (neck) area
  • Numbness or tingling in the legs
  • Sciatic pain radiating into the leg
  • Pain might increase while bending, sitting or twisting

If you observe one of these symptoms on a regular basis you should contact our back and spine department to arrange a thorough diagnostic examination of your spine and spinal discs.

Chronic back pain and spinal disc degeneration is a common problem many patients experience after a spinal disc herniation (prolapsed disc). After the herniated disc has been treated successfully by physiotherapy or removal of prolapsed disc material, the spinal disc suffers a volume reduction. Degenerated discs are less effective as shock absorbing cushions between the vertebrae of the human spine, and are therefore less able to protect the nerve roots and spinal cord.

Although discs may degenerate anywhere in the spine, certain areas in the neck and in the lower back suffer particularly due to our sedentary lifestyle.

Consequences of spinal disc degeneration

  • Herniated spinal discs
  • Osteoarthritis of the vertebrae
  • Spondylophytes (bone spurs) on the vertebrae resulting from friction
  • Stenosis: narrowing of the spinal canal causing pressure on the nerves

Whether as part of the natural ageing process, or resulting from traumatic disc herniation in a young athletic adult, the process of spinal disc degeneration, has historically seemed to be irreversible.

With the invention of autologous disc cell transplantation (ADCT) however, there is growing evidence that spinal disc cell based treatments can indeed restore the volume, elasticity, height and resilience of a degenerated spinal disc.

ADCT "Disc Cell Transplant" Terminology

  • ADCT: Autologous Disc Cell Transplant
  • Autologous: From the body´s own cells. No "alien" materials are introduced
  • Disc: Vertebral Spinal Disc
  • Laboratory Process: In a carefully designed Laboratory process the disc cells multiply in a serum prepared from the patient´s own blood serum
  • Regeneration: The biological potential for natural disc regeneration is very limited because spinal discs have no blood supply.
ADCT-Autologous DISC Cell Transplant Spinal discs have a limited biological potential for regeneration once the process of disc degeneration has started. © Viewmedica

Artificial disc cell transplant is biological regeneration of spinal discs. ADCT is designed to compensate for the reduction in volume and elasticity of a degenerated or prolapsed spinal disc. In a specialised procedure, disc cell material is removed from the spine and grown in a laboratory. After 12 weeks a large amount of disc cells can be re injected into the the degenerated disc, via a minimally invasive procedure. This Autologous Disc Cell Transplant has the potential to increase the volume and elasticity of spinal discs.

Case Report: Spinal disc regeneration after disc herniation in a young soccer player

Goal Keeper Exemplary Illustration © By U.S. Air Force photo by Master Sgt. Lance Cheung, via Wikimedia Commons

A 21 year-old goalkeeper from a professional football team in North Africa suffered sudden back pain during training.

MRI examination found the cause to be a massive disc herniation. The prolapsed material was pressing on a nerve root in the segment L5/S1, resulting in severe back-pain, sciatic pain numbness and muscle weakness in the right leg. The athlete had to stop training and competition immediately.

Two months of conservative treatment under the supervision of a physical therapist did not improve the symptoms. Because of the risk of "failed back surgery" with painful scar formation, the teams physician did not recommend open spine surgery. After thorough investigation, the back and spine centre at the Gelenk-Klinik Hospital in Germany, advised a fully-endoscopic surgical procedure to remove the prolapsed disc. This operation was carried out by Dr. Haberstroh and the consultant Neurosurgeon Bijan Ganepour.

The volume of the herniated spinal disc was found to be reduced by approximately 30%. This herniation would have been interfering with the function of the spinal disc and causing the chronic back pain.

In order to improve the long term prospect of this young patient, the surgeon decided to perform an autologous disc cell transplantation.

A portion of the endoscopically removed tissue from the herniation was sent to a special laboratory for cell regeneration.

Twelve weeks after the endoscopic removal of the prolapsed disc material, the patient's isolated disc cells had proliferated to a significant volume in a sterile container.

Spinal disc cell transplantation was then performed. The new inter-vertebral disc cells were introduced by endoscopic injection directly into the nucleus of the spinal disc, the spinal disc volume increased as a result, serving as an intervertebral cushion with renewed efficiency. The tear on the ruptured spinal disc healed and the disc became stable once again.

This was confirmed by a follow up MRI investigation.

After intensive physio therapeutic rehabilitation with specific exercises to strengthen the back, the athlete was passed as being fit for training and competition.

Disc herniation and degenerative disc disease

Many patients, particularly following disc herniation, suffer recurrent or persistent back and leg pain. Approximately 10% of patients with spinal disc compression need repeated surgery over time.

70% of patients having had spinal decompression surgery, will experience back pain again at some time in the future.

This is because of the ongoing process of spinal disc degeneration with a progressive loss of spinal disc tissue, following injury to the disc, or traumatic herniation.

The degenerated disc slowly loses height, volume and elasticity. As the disc degenerates, small tears in the disc wall can allow part of the high pressure liquid core material of the spinal disc to escape into the area around the spinal column.

Indications for ADCT Biological Disc Cell Regeneration

  • Spinal Disc Herniation
  • Spinal Disc Protrusion
  • Discogenic Pain Syndrome
ADCT-Autologous Disc Cell Transplant Structural integrity of the degenerated spinal disc is essential for a successfull disc cell transplant. The annulus fibrosus (fibre ring surrounding the spinal disc) can be investigated by MRI imaging. That is one of the reasons why an ADCT can be performed only 12 weeks after the incident of a spinal disc herniation. © Viewmedica

Degenerative disc disease can occur both in the lumbar (lower back) and in the cervical (neck) areas of the spine.

After spinal disc herniation disc volume is often decreased

When to look for alternative treatments

  • Loss of disc volume of more than 50%
  • Spinal stenosis
  • Unstable vertebrate Spine (Spondylolisthesis)
  • Severe Spondylophytes - friction between vertebral bodies leading to bone spurs
  • Severe neurological symptoms
  • Osteoarthritis of facet joints
  • Severe disc injury and disrupted disc morphology

If you are experiencing any of the above, please contact us to discuss treatment options with our spine specialist.

Principle of Autologous Intervertebral Disc Cell Transplantation

As the spinal disc is not able to re-generate cell tissue by itself, it is not able to compensate for the lost disc material.

Effectiveness of ADCT

Efficiency of ADCT

ADCT has been available since 1996. Studies have shown a greater than 80% success rate for Autologous Disc Cell Transplant in reducing chronic back pain (5 year follow up study). ADCT is particularly effective with young and active patients. For these patients ADCT provides a regeneration oriented approach to spinal disc therapy. ADCT has the potential to increase the volume and restore the function of the degenerated spinal disc. ADCT treatment can prevent disc related back pain.

We have histological evidence that the reinjected cartilage cells will stay alive in the spinal disc and will continue to produce connective tissue (extracellular matrix). Living cells are essential to maintain the mechanical function of the spinal disc.

Follow up investigations after five years with more than one hundred ADCT patients, show very encouraging clinical results: spinal discs are stable and the restored function remains. Patients experience less pain and less disc degeneration.

Alternative treatments

If ADCT is no longer possible, one of the following treatment strategies should be considered as an alternative.

Please contact our Spine centre for a thorough investigation and to discuss treatment options.

ADCT is still a relatively new procedure and it is not yet considered a standard treatment in the prevention of spinal disc degeneration. However it already shows significant promise, especially in comparison with other procedures which top up the reduced volume of the herniated disc (using collagen or hyaluronic acid).

ADCT is most effective, if used soon after disc herniation or traumatic injury.

ADCT can preserve the healthy and vital function of the spinal disc without the side effects associated with the introduction of "foreign" material into the body.

Disclaimer

It is necessary to acknowledge the fact that ADCT is not yet considered a standard procedure. The procedure of disc regeneration via tissue engineering is safe, although, the long term benefits of ADCT are still the object of intense academic discussion and clinical research. At the Gelenk-Klinik, however, we are delighted to be able to apply this modern and safe technique, in order to improve the quality of life of many of our spinal disc patients.

Autologous Disc Cells: Extra corporal cultivation of your own disc cells

Advantages of autologous inter vertebral discs - cell transplantation

  • Treatment with autologous cells - no foreign tissue
  • Reduction of the need for future surgery
  • Minimally invasive delivery of body's own laboratory grown cells
  • Compensation for the loss of mass in the defective disc
  • Regeneration of healthy disc tissue
  • Preservation of the functionality of the disc
  • Conservation of flexibility of the back
  • Protection against further disc degeneration

Experience and expertise with Autologous Disc Cell Transplant (ADCT)

Specialists at the orthopaedic Gelenk-Klinik have been using the ADCT process since 1996. Studies following patients for more than five years show very positive long term outcomes for patients with degenerative disc disease. The orthopaedic hospital Gelenk-Klinik has an excellent track record of performing cartilage transplant surgery for more than 800 patients in knee, ankle and spine surgery since 1996.

Treating degenerative Disc Disease with ADCT

 

Process of Spinal Disc Cell Cultivation in the laboratory

Process of Autologous Spinal Disc Cell Transplant (ADCT)

  • Harvesting of herniated disc material or endoscopic extraction of a small amount of spinal disc material
  • Cleaning process of herniated disc material
  • Cell proliferation in autologous serum for 3 months
  • Injection of cells into spinal disc under local anaesthesia
  • 2 nights of inhouse treatment

Transplantation of the body´s own cells requires the sophisticated biological processing of cell cultures. To achieve this purpose, it has been necessary to develop a special cell culture process.

The physician will harvest the spinal disc tissue removed during nerve decompression surgery. From this sample of inter vertebral disc tissue, healthy cartilage cells are isolated and proliferated (grown). This proliferation will take place in an autologous serum (serum prepared from your own blood). Animal serum is not used for this process. This cultivation using serum from the patient, is unique to the CODON procedure.

After twelve weeks the cells will have multiplied to a significant mass and at the same time the spinal disc will have formed stable scar tissue following disc decompression surgery.

Transplant of autologous disc graft by injection

The newly grown cells can be transplanted back into the affected disc. Immediately after being reintroduced into the spinal disc, they form new inter vertebral disc tissue.

This innovative method, the endogenous disc chondrocyte transplantation (autologous disc-derived chondrocyte transplantation ADCT) is typically used following disc herniation.

The ability to compensate for defective tissue, exclusively using autologous disc cells (without introducing artificial or foreign material) in the body, is a unique feature of ADCT.

ADCT-Autologous DISC Cell Transplant The 3 Steps of Autologous Disc Cell Transplant: 1. Harvesting of spinal disc cells 2. Proliferation of spinal disc cells in a laboratory process. 3. Re implantation of cells into the spinal disc to increase volume and resilience of the disc © Codon

 

Step by step process of inter vertebral disc cell transplantation (ADCT)

Step 1. Removal of disc tissue

Approximately 1ml of disc tissue is removed from the patient along with a blood sample (200 ml)

Step 2. Proliferation of inter vertebral disc cells in a laboratory

In highly specialised cell culture laboratories, adhering to the highest safety standards and under sterile conditions, the inter vertebral disc cells are isolated from the tissue sample and cultured (grown). This cell growth is a highly controlled and supervised process that complies with the highest standards of quality management. (AMG, GMP, ISO 9001:2000).

Step 3. Transplantation of Intervertebral Disc Cells

The transplantation of the cultured inter vertebral disc cells takes place approximately 3 months after the removal of the inter vertebral disc tissue. This time interval ensures that the fibrous ring structure of the inter vertebral disc has healed sufficiently to contain the transplanted cells. Under local anesthesia, the new, endogenous disc cells are injected into the inter vertebral disc.

Rehabilitation and exercise necessary following ADCT

Rehabilitation after ADCT

  • Precaution: Patient stays in bed for 24 hours after the injection of autologous disc cells
  • Inhouse supervision for 2 nights after disc cell injection
  • Physical work only 4 weeks after disc cell injection
  • Sports and training 4 weeks after the disc cell injection
  • Out patient physiotherapy for 4 weeks is recommended
  • 4-6 weeks of back braces recommended

Rehabilitation and back training is a very important aspect of Autologous Disc Cell Transplantation (ADCT). As a precaution you should remain as an inpatient for the two nights following the transplantation of autologous disc cells. Due to the high pressure in the spinal discs, this period of rest serves as a precaution to prevent the transplanted cells from herniating through the injection site of the disc.

After the successful injection of disc cells inpatient or outpatient rehabilitation with a physiotherapist is required in order to receive the full benefit of the ADCT-procedure. It is normally possible to fly back home three nights after the ADCT treatment.

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Orthopaedic Clinic Germany

orthopedic clinic and surgeon in Germany

Gelenk Klinik Orthopaedic
Clinic

ISO 9001:2008 certified quality

Street:
Alte Bundesstrasse 58

Town:
D-79194 Gundelfingen

Germany

Back & Spine Specialists

Team of orthopedic surgeons in Germany

Bijan Ganepour
Expert Consultant for Spine and Neurosurgery

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  • Distance to EURO-Airport Basel: 80 km (45 mins)
  • Distance to Zurich: 161 km (1h 40)
  • Distance to Frankfurt: 259 km (2h 20)

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