A new pilot study from Weill Cornell Medicine suggests that delivering a patient’s own bone marrow–derived cells during lumbar microdiscectomy is both safe and feasible, representing an early step toward biologic strategies that may one day help preserve spinal disc health. The prospective study, published in World Neurosurgery, provides early human safety data for using autologous bone marrow aspirate concentrate (BMAC) to address disc degeneration in surgery.
The study was led by Roger Härtl, MD, Professor of Neurological Surgery at Weill Cornell Medicine, with contributions from neurosurgeons, scientists and trainees across the department. The findings represent a measured step toward integrating biologic strategies into standard spine surgery.
Dr. Roger Härtl
Addressing a Limitation of Established Surgical Care
Lumbar microdiscectomy is a well‑established and effective procedure for alleviating acute radicular pain caused by disc herniation. However, it does not restore disc biology or halt the degenerative process, which may continue for years after surgery.
“We are very effective at treating acute pain,” Härtl said. “What we currently lack are treatments that prevent the disc from degenerating further, which can lead to significant back pain ten to fifteen years later.”
Biologic therapies using a patient’s own bone marrow‑derived cells have shown promise in nonoperative settings for disc‑related back pain. This pilot study explored whether such an approach could be safely incorporated into the operating room at the time of microdiscectomy.
A Safety‑Focused Study Design
The single‑center prospective pilot study enrolled 27 adult patients undergoing lumbar microdiscectomy who also received a 1 mL intradiscal injection of autologous BMAC during surgery. Patients were followed for one year, with outcomes focused primarily on safety and feasibility.
“From a translational research standpoint, establishing safety is the essential first step,” said Ibrahim Hussain, MD, neurosurgeon at Weill Cornell Medicine and coauthor of the study. “This pilot was designed to determine whether a biologic adjunct could be introduced during a standard lumbar microdiscectomy without adding risk to patients.”
Primary endpoints included procedure‑related complications, readmissions, reoperations and same‑site recurrence. Secondary outcomes included patient‑reported measures of disability and pain, while exploratory quantitative MRI was used to assess disc composition.
Early Findings Support Feasibility
The investigators observed no intraoperative or postoperative complications related to the BMAC injection. One patient experienced a same‑site recurrence that was managed without reoperation. Among patients with available imaging data, quantitative MRI showed no adverse changes in disc composition through one year.
“It is important to be clear about what these data do and do not show,” Dr. Härtl said. “This study demonstrates safety and feasibility, not clinical efficacy. That distinction is critical when evaluating early‑stage biologic interventions.”
Although patient‑reported outcomes improved among individuals with completed follow‑up, the authors emphasize that the uncontrolled design and limited sample size preclude conclusions about treatment benefit.
Dr. Ibrahim Hussain
Implications for Future Research
Biologic adjuncts in spine care have historically been used outside the operating room. This study evaluates a different paradigm by integrating a biologic intervention directly into a surgical procedure.
“The value of this work is how it informs the next step,” Dr. Hussain said. “If prospective randomized trials ultimately show benefit, this approach could influence how we think about preserving disc health. But that evidence has to be generated carefully.”
The authors conclude that their findings support the feasibility of larger, controlled and multicenter trials with longer follow‑up to determine whether intradiscal BMAC delivered at the time of surgery can influence disc regeneration, long‑term back pain or recurrence rates.
“At this stage, these data do not change clinical practice,” Dr. Härtl said. “They provide the foundation for future investigation.”
The work reflects Weill Cornell Medicine’s broader commitment to advancing evidence‑based innovation in spine care through carefully designed clinical research.
Read the full paper here: https://www.sciencedirect.com/science/article/pii/S1878875026002147?via%3Dihub
Authors
Alikhan B. Fidai, PhD; Jessica Berger, BS; Anthony Robayo, BA; Ahmet Kartal, MD; Chibuikem Ikwuegbuenyi, MBBS; Ashley Cardenas, BS; Jonathan P. Dyke, PhD; Ibrahim Hussain, MD; Lawrence J. Bonassar, PhD; and Roger Härtl, MD.
Learn More
To learn more about spine research and clinical programs within the Department of Neurological Surgery at Weill Cornell Medicine, visit:
https://neurosurgery.weill.cornell.edu/