Disclosures: John Taylor Mansfied, DO: Nothing to disclose

Case Description: This patient presented with insidious onset low back and right leg pain of 10 months duration. Workup with x rays, MRI, and eventually CT imaging with 3D reconstruction which revealed evidence of bilateral L4 spondylolysis without -listhesis. Initial steps in management included physical therapy for core strengthening and stabilization, home exercise program including flexion-neutral strengthening exercises, LSO bracing, oral medications, epidural steroid injection ×2, and adequate time allotment for bony healing. In spite of the aforementioned treatments, though mildly improved, the patient continued to have low back pain with radiculitis. Due to both persistent pain as well as concern for progression to spondylolisthesis, the patient was interested in additional non-surgical treatment options to address these concerns. After thorough discussion of available option, the decision was made to proceed with iliac crest harvested bone marrow aspirate concentrate (BMAC) medicinal signaling cells (MSC) injection. 5 mL were injected bilaterally into the pars defect under fluoroscopic guidance. Patient was discharged in LSO brace.

Setting: Interventional pain outpatient clinic.

Patient: 29-year-old male with bilateral spondylolysis.

Assessment/Results: In the 6 months prior to MSC injection, the patients pain ranged between 1-3/10 on the numerical pain rating scale (NPRS). At 5 weeks post-MSC injection, the patient’s pain was 1/10 on the NPRS. Functionally, the patient was now able to sit for prolonged periods of time, which prior to injection he was unable due to pain. The patient will have follow up CT imaging with 3D reconstruction 3 months post procedure to assess for bony healing.

Discussion: This is the first reported case, to our knowledge, of either spondylolysis or spondylolisthesis treated with advanced imaging guided MSC injection.

Conclusion: There exists limited options for the treatment of persistently painful and/or non healing pars defects. Regenerative injection therapy, such as MSCs, might provide an additional non-surgical option for management in these cases.

Level of Evidence: Level V

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PM&R Meeting Abstracts - https://pmrjabstracts.org/abstract/fluoroscopic-guided-medicinal-signaling-cells-injection-for-the-treatment-of-bilateral-spondylolysis-a-case-report/