La medicina regenerativa promete reparar discos dañados y aliviar el dolor lumbar discogénico. En 2025 existen ensayos clínicos y revisiones que muestran señales de eficacia en subgrupos, pero la evidencia aún es heterogénea y, en muchos casos, preliminar. No es una solución universal ni sustituye a la rehabilitación ni a las opciones quirúrgicas bien indicadas. Este artículo explica, con lenguaje claro, cuándo puede tener sentido valorar terapias celulares o PRP, qué resultados son realistas, qué riesgos existen y cómo integrarlas en un plan de cuidado seguro.
- Intradiscal cell therapies and PRP can offer modest benefits for some people with persistent discogenic pain, but they don’t “cure” every back.
- Careful case selection is key: confirmed discogenic pain, failure of well-structured conservative care, and no significant segmental instability.
- Outcomes are usually tracked in pain and function; improvements are gradual (weeks to months).
- There are risks (infection, pain flare, costs) and regulatory frameworks that limit use outside clinical trials.
- They should be combined with therapeutic exercise, pain education and, when appropriate, other interventions.
What is regenerative medicine for the spine?
It refers to biological therapies aimed at repairing disc tissue or modulating inflammation. This includes cell concentrates (e.g., mesenchymal stromal/stem cells) and blood-derived products such as platelet-rich plasma. The goal is to reduce pain and improve function while preserving motion when possible.
Symptoms and indications: who might be a candidate?
- Chronic low back pain suspected to be discogenic (midline pain, worse with sitting, positive provocation tests).
- Mild radiculopathy from a contained protrusion without relevant instability.
- Failure of a well-designed conservative program for at least 6–12 weeks (exercise, education, prudent medication, psychosocial management).
Not a good indication when there is marked instability, severe central stenosis, relevant deformity, infection, tumors, or progressive neurological deficit: these scenarios require a different approach.
Diagnosis: confirming the disc as the pain source
History and neurological exam guide the diagnosis. MRI helps localize degenerative changes and indirect signs (e.g., Modic changes), but it is not sufficient on its own—clinical correlation is essential. In selected cases, dynamic X-rays help rule out instability and, in specialized settings, diagnostic interventional tests may be considered. Before any biological therapy, verify that imaging findings explain the current symptoms.
Treatment alternatives
Non-surgical
- Therapeutic exercise and pain education: the cornerstone of initial care.
- Rational analgesia (avoid long-term opioids), psychosocial approach, and active physiotherapy.
- Epidural or facet injections in selected cases with an inflammatory component.
Biological (regenerative)
- Platelet-rich plasma (PRP), intradiscal or peridiscal: aims to modulate inflammation and support tissue repair. Evidence suggests improvements in pain and function for a subset of patients, with variability across studies.
- Mesenchymal stromal/stem cells (MSCs), autologous or allogeneic: injected into the disc to promote a reparative environment. Controlled trials show acceptable safety and signals of efficacy in subgroups; others find no clear short-term advantage versus placebo.
Surgical
- Targeted decompression when there is significant nerve root compression.
- Fusion or disc replacement for refractory discogenic pain with instability or deformity, after multidisciplinary assessment.
Expected benefits vs risks/adverse effects
Benefits
- Gradual pain reduction and functional gains in well-selected subgroups.
- Minimally invasive procedures with quick recovery.
- Potential to delay or avoid surgery in some cases.
Risks and limitations
- Heterogeneous results across studies; improvement is not guaranteed.
- Adverse effects: transient pain increase, infection, bleeding, rare allergic reaction.
- Cost and availability; regulatory constraints limiting indications outside trials.
Practical criteria for referral/specialist assessment
- Persistent discogenic low back pain with functional impact after 6–12 weeks of well-executed conservative care.
- MRI consistent with a disc source and no relevant instability.
- Patient motivated to combine biological therapy with structured rehabilitation and lifestyle changes.
- Rule out red flags (infection, tumor, cauda equina) and other major pain generators (facet, sacroiliac) before disc injection.
Realistic recovery timelines
- Day 0–2: manageable local soreness; early ambulation.
- Week 1–4: gradual return to light activities; start/continue therapeutic exercise.
- Month 2–3: peak functional gains in responders; adjust analgesia and strengthening program.
Timelines vary with age, comorbidities, number of treated levels, and coexisting pain sources.
When to seek urgent care?
- High fever, severe disproportionate pain, or rapid worsening after the procedure.
- Progressive weakness, saddle anesthesia, or new bladder/bowel dysfunction.
Myths and realities
- Myth: “Stem cells regenerate any disc.” Reality: outcomes depend on case selection and structural damage.
- Myth: “PRP is the same for everyone.” Reality: preparation and injection site influence results.
- Myth: “If I get cells, I’ll never need surgery.” Reality: it may delay surgery for some; in others, surgery remains the right option.
Frequently asked questions
Who is a good candidate for a regenerative therapy?
People with confirmed discogenic pain, no significant instability, and after exhausting well-directed conservative measures.
What tests do I need beforehand?
Clinical and neurological assessment, MRI, and—if needed—additional studies to rule out other pain sources.
When will I notice improvement?
Gradually, over weeks; in responders the peak typically appears between 6 and 12 weeks.
What risks exist?
Transient pain, uncommon infection, bleeding, or lack of clinical response.
Does it replace physiotherapy?
No. It should be integrated into a plan that includes exercise and pain education.
Is it approved in all countries?
Regulatory frameworks vary. Some indications remain limited to clinical studies.
Is it useful if I have severe central stenosis or instability?
It is not the right option: these conditions require other strategies, sometimes surgical.
Can I work after the procedure?
Many patients return to light duties within 1–2 weeks, depending on progress and job type.
Glossary
- Discogenic pain: pain originating from the intervertebral disc.
- MSC: mesenchymal stromal/stem cells with reparative and immunomodulatory potential.
- PRP: platelet-rich plasma, an autologous concentrate rich in growth factors.
- Instability: abnormal motion of a spinal segment that can cause pain.
- Red flags: warning signs that warrant urgent evaluation.
References
- Complex Spine Institute: Regenerative Medicine: Stem Cells for Spinal Disorders
- NICE. Low back pain and sciatica in over 16s: assessment and management (updated 2020). https://www.nice.org.uk/guidance/ng59 (2020).
- NASS. Clinical Guidelines (spine guideline portal). https://www.spine.org/Research/Clinical-Guidelines (accessed 2025).
- Amirdelfan K, et al. Allogeneic mesenchymal precursor cells for discogenic low back pain: randomized, controlled, 36-month follow-up. https://pubmed.ncbi.nlm.nih.gov/33045417/ (2021).
- Vadalà G, et al. Autologous BM-MSC intradiscal injection: phase IIB randomized trial (preliminary). https://pmc.ncbi.nlm.nih.gov/articles/PMC12129703/ (2025).
- Machado ES, et al. Systematic review of PRP for low back pain. https://pmc.ncbi.nlm.nih.gov/articles/PMC10525951/ (2023).
- FDA. Important patient and consumer information about regenerative medicine therapies. https://www.fda.gov/vaccines-blood-biologics/consumers-biologics/important-patient-and-consumer-information-about-regenerative-medicine-therapies (2021).
Disclaimer: This content is educational and does not replace individualized medical evaluation.
