Cryopreserved amniotic membrane and umbilical cord particulate for managing pain caused by facet joint syndrome

Abstract

Treatment of back pain due to facet joint syndrome has been a challenge for physicians since its recognition ∼80 years ago. Intra-articular injections of steroids, local anesthetics, and phenol have been widely adopted despite their known shortcomings. Recently, intra-articular injection of amniotic membrane-umbilical cord (AMUC) has been utilized in various orthopedic indications, including those involving synovial joints, due to its reported anti-inflammatory properties. Herein, use of AMUC for facet joint syndrome was evaluated.A single-center case series was conducted on patients presenting with pain caused by facet joint syndrome, confirmed by single blocking anesthetic injection and treated using a single intra-articular injection of 50 mg particulate AMUC (CLARIX FLO) suspended in preservative-free saline. Patient reported back pain severity (numerical scale 0–10) and opioid use were compared between baseline and 6 months following treatment.A total of 9 patients (7 males, 2 females), average age 52.1 ± 15.9 years, were included. Five patients with cervical pain had a history of trauma, 1 patient had suffered lumbar facet injury and 3 had degenerative lumbar facet osteoarthritis. All patients had severe pain prior to injection (8.2 ± 0.8) and 4 (44%) were taking opioids (>100 morphine milligram equivalents). Six-month post-treatment, average pain had decreased to 0.4 ± 0.7 (P <.05). All patients had ceased use of prescription pain medications, including opioids. No adverse events, repeat procedures, or complications were reported.Intra-articular injection of AMUC appears to be promising for managing facet pain and mitigating opioid use. Further investigation with larger sample size is warranted.

Amniotic membrane/ umbilical cord particulate injection for achilles tendinopathy with or without a partial tear

“…These preliminary results suggest a beneficial role of AMUC in Achilles tendinopathy patients with or without partial tendon tears and are also consistent with prior studies in which AMUC was beneficial in patients with other various musculoskeletal injuries. 5,6 The benefits of AMUC injections in musculoskeletal pathologies might be based on its reported therapeutic actions in reducing inflammation, inhibiting scar tissue formation, and supporting stem cell function. AMUC contains growth factors, cytokines and peptide complexes including HC-HA/PTX3, which has been shown to promote apoptosis of activated but not resting macrophage, phagocytosis of apoptotic neurophils, polarization of anti-inflammatory macrophages, and suppression of Th1 cells.…”

“…Recent studies have provided preliminary safety and effectiveness data of amniotic membrane/umbilical cord particulate (AMUC) injections in patients with various musculoskeletal injuries including plantar fasciitis, knee osteoarthritis, facet osteoarthritis pain, rotator cuff tears, and meniscal tears. 5,6 These studies observed clinical benefits of AMUC including long-lasting pain relief and rapid functional recovery, with an observed reduction of opioid use in some studies. 5,6 Further basic research studies have provided evidence that AMUC downregulates inflammation, reverts scar formation, and promotes a regenerative environment which supports the clinical effects seen in patients.…”

“…5,6 These studies observed clinical benefits of AMUC including long-lasting pain relief and rapid functional recovery, with an observed reduction of opioid use in some studies. 5,6 Further basic research studies have provided evidence that AMUC downregulates inflammation, reverts scar formation, and promotes a regenerative environment which supports the clinical effects seen in patients. Based on these clinical findings and the wellestablished therapeutic properties of AMUC, this study investigated the safety and effectiveness of AMUC injections in Achilles tendinopathy patients with or without a partial tendon tear.…”

Nonoperative treatment of recalcitrant neuritis of the infrapatellar saphenous nerve: a case series

“…Hence, there is a current unmet clinical need for treating IPS neuritis nonsurgically. Amniotic umbilical cord particulate is known to be antiinflammatory, antiscarring, and proregenerative and has been used in many orthopedic applications such as plantar fasciitis, facet joint syndrome, and knee osteoarthritis to reduce pain [15][16][17][18][19][20]. This case series highlights the use of amniotic umbilical cord particulate injection for the symptomatic improvement of recalcitrant neuritis of the IPS.…”

Amnion and Umbilical Cord–Derived Products in Sports Medicine: From Basic Science to Clinical Application

“…Liquid products are intended for direct intra-articular injection for the treatment of pain associated with osteoarthritis of the appendicular skeleton or facet joints. 4,12 Liquid products are typically either amniotic fluid or cord blood. In some cases, particulate amnion tissue is added to amniotic fluid.…”