The United States has the largest number of stem cell clinics in the world. For anywhere between $2,500 to upwards of $20,000 cash, anyone can have stem cells injected in their spine. Most clinics offering this therapy advertise the regenerative nature of their procedure. “…industry-leading experience”, “… published research”, “… specialized training”. I’ve personally heard the radio ads with patient testimonials.
The problem is that little proof exists that stem cell-based treatments work. (The exception is bone marrow transplants, which is not the topic of this blog). Stem cell spine injections are not FDA approved. While it is apparent that if stem cells achieved anywhere near the results advertised, then insurance companies would approve this therapy, legitimate spine conferences around the world would discuss the research, patients would rarely undergo any other spine procedure, and the team at Rocky Mountain Brain & Spine Institute would be performing them. Yet, none of this is happening.
The power of placebo is amazing. Placebos do not contain or do anything, but somehow produce an effect on an individual. Numerous ailments, including chronic pain, depression and even high blood pressure, have been treated with placebo. Any benefit from stem cell therapy is likely related to placebo.
In defending stem cells, some patients may offer… If the money is not an issue and everything else has been tried, then what’s the worst that could happen?
Unfortunately, a whole heck of a lot. In 2018, Stem Cells Translational Medicine journal published adverse events in patients receiving unproven stem cell-based interventions.
The concept behind stem-cell therapy is that in the infancy of a cell’s life, it potentially can turn into any type of cell. Based on the genetic program and chemicals in the local environment, the cell morphs into something specialized. Therefore if doctors could capture that stem cell, place it in an injured area of a patient’s body, and then direct the stem cell to regenerate and fix the injury, then a multitude of diseases could be cured, including spine pain.
The problem is that, even in 2019, we cannot accurately direct that stem cell the way we desire. Most of the time the stem cell just turns into harmless scar tissue, although other times a major problem can develop. According to the 2018 study, 35 cases describing acute or chronic complications or death following stem cell implants were reported.
One of the most dangerous complications from stem cell therapy is tumor formation. In 2001, a 13-year-old child received stem cell injections for a hereditary condition. Four years later, the child developed headaches and was found to have a cancerous brain tumor, called a glioblastoma multiforme (GBM). Tissue from the tumor was analyzed and genetically confirmed the cells were from the same line as the stem cell implant. Most recent in July 2019 in CMAJ, a spinal cord tumor was found in a 38 year old man, and the pathology linked the cells to his experimental treatment from 12 years earlier.
So how could these complications happen if there is literature referenced by these stem cell centers? Isn’t all medicine based on research and literature? The studies quoted by stem cell centers tend to be poorly organized, with short follow-ups and no control group to see if a placebo effect occurred. They are not published in peer-reviewed or respected journals. And even if these stem cell centers were scrupulously reporting complications, most of these tumor and deaths occur long after the “study period” ended.
In summary, many patients who run out of conventional options seek hyped up, seemingly cutting-edge, treatments. But the “worst-case-scenario” is not that stem cell therapy may just not work… the worst case is death or cancerous tumor formation.