We have been involved in the drive towards mesenchymal stem cell reconstruction of degenerate discs for well over a decade. Whilst we can convert stem cells into disc cells the structural environment needs to be rebuilt. Currently Gelstix and Fehrfix polymer reconstruction systems are showing promise but are not yet ready to take the stem cells optimally.
However the insertion of these polymer products does increase disc height and thereby enlarge the pathway for the nerves leaving the spine so relieving pressure on these nerves. This results in a reduction in neck or low back pain and should restore a measure of improved function to the disc.
Our experience with these products dates from 2011 and we have carefully monitored outcomes. We test the integrity and thickness of the disc wall by inserting a contrast medium which shows whether the disc wall is bulging or leaking on the X-rays. Sadly some practitioners are not doing this. CT and MRI scans do not show the competency of the disc wall, so the “blind” insertion of these products will lead to extrusion. Despite these precautions we have 2 patients in our Gelstix lumbar series of 150 patients who have micro-extruded – thankfully without producing any symptoms. We have had one patient in our 16 cervical series of patients who had an extrusion which has gradually resorbed, leaving the patient with his original symptoms and requiring conventional surgery. These outcomes highlight the need for great caution in patient selection
Only Gelstix is available for cervical implantation and Gelstix is available for lumbar reconstruction. Fehrfix swells faster and is supplied with a larger polymer volume. The insertion system that we employ avoids making a second entry into the disc reducing the risk of extrusion.
