Rajkovic CJ, Merckling ML, Lee AW, Subah G, Malhotra A, Thomas ZD, Zeller SL, Wainwright JV, Kinon MD. Conservative management of spinal pathology with autologous conditioned serum: A systematic review of the literature. World J Orthop 2024; 15(9): 870-881 [PMID: 39318497 DOI: 10.5312/wjo.v15.i9.870]
Corresponding Author of This Article
Christian J Rajkovic, BSc, Researcher, Department of Neurosurgery, Westchester Medical Center, 40 Sunshine Cottage Road, Valhalla, NY 10595, United States. crajtkotp@gmail.com
Research Domain of This Article
Orthopedics
Article-Type of This Article
Systematic Reviews
Open-Access Policy of This Article
This article is an open-access article which was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution Non Commercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: http://creativecommons.org/licenses/by-nc/4.0/
World J Orthop. Sep 18, 2024; 15(9): 870-881 Published online Sep 18, 2024. doi: 10.5312/wjo.v15.i9.870
Conservative management of spinal pathology with autologous conditioned serum: A systematic review of the literature
Christian J Rajkovic, Matthew L Merckling, Alyssa W Lee, Galadu Subah, Aryan Malhotra, Zachary D Thomas, Sabrina L Zeller, John V Wainwright, Merritt D Kinon
Christian J Rajkovic, Matthew L Merckling, Alyssa W Lee, Galadu Subah, Aryan Malhotra, Zachary D Thomas, Sabrina L Zeller, John V Wainwright, Merritt D Kinon, Department of Neurosurgery, Westchester Medical Center, Valhalla, NY 10595, United States
Co-corresponding authors: Christian J Rajkovic and Merritt D Kinon.
Author contributions: Rajkovic CJ was responsible for designing the review protocol, writing the protocol and report, conducting the search, screening potentially eligible studies, extracting and analyzing data, interpreting results, writing the manuscript, updating reference lists, and creating figures and tables; Merckling ML was responsible for screening potentially eligible studies, extracting and analyzing data, interpreting results, and writing the manuscript; Lee AW was responsible for screening potentially eligible studies and creating the PRISMA figure; Malhotra A, Thomas ZD was responsible for screening potentially eligible studies; Subah G, Zeller SL, Wainwright JV and Kinon MD was responsible for designing the review protocol, screening potentially eligible studies, assessing bias in included studies, writing the manuscript, and providing feedback.
Conflict-of-interest statement: Dr. Merritt Kinon reports stock and honorarium with Globus Medical, Inc and is a consultant for Sanara MedTech. The remaining authors have no conflicts of interest to disclose.
PRISMA 2009 Checklist statement: The authors have read the PRISMA 2009 Checklist, and the manuscript was prepared and revised according to the PRISMA 2009 Checklist.
Open-Access: This article is an open-access article that was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution NonCommercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: https://creativecommons.org/Licenses/by-nc/4.0/
Corresponding author: Christian J Rajkovic, BSc, Researcher, Department of Neurosurgery, Westchester Medical Center, 40 Sunshine Cottage Road, Valhalla, NY 10595, United States. crajtkotp@gmail.com
Received: March 18, 2024 Revised: August 22, 2024 Accepted: August 28, 2024 Published online: September 18, 2024 Processing time: 178 Days and 1 Hours
Abstract
BACKGROUND
Chronic inflammatory pain is associated with increased expression of interleukin (IL)-1, an inflammatory cytokine, and activity on its receptor (IL-1R). In response, the body produces IL-1R antagonist (IL-1Ra) to reduce this signaling. Autologous conditioned serum (ACS) is the only biologic therapy for spinal pathologies that enhances the action of endogenous IL-1Ra reserves to improve symptoms. This systematic review investigates the effectiveness of ACS in treating pain and disability caused by spinal pathologies.
AIM
To evaluate the use of ACS as a conservative management option for spinal pathology.
METHODS
A systematic review of PubMed/Medline was performed to identify studies investigating administration of ACS for treatment of any spinal pathology.
RESULTS
Six articles were included, comprising 684 patients treated with epidural (n = 133) or transforaminal (n = 551) ACS injections. Patients had an average age of 54.0 years with slight female predominance (53.2%). The lumbar spine was most commonly treated, with 567 patients (82.9%) receiving injections for lumbar radiculopathy (n = 67), degenerative disc disease (DDD) (n = 372), or spinal stenosis (n = 128); cervical injections were performed in 109 patients (15.9%). Mean (SD) follow-up was 21.7 (4.8) weeks from first ACS injection. All studies investigating mechanical lumbar and lumbar or cervical radicular pain reported significant pain reduction at final follow-up compared to baseline. ACS achieved comparable or superior results to lumbar epidural steroid injections. Adverse events were reported in 21 patients (3.1%), with no serious adverse events.
CONCLUSION
ACS injection is a safe and effective intervention for pain reduction in many spinal pathologies, including cervical and lumbar radiculopathies.
Core Tip: Injections of autologous conditioned serum (ACS) are an emerging conservative management strategy for reducing inflammation and pain in various osteoarthritic conditions. This therapy extracts and amplifies the novel anti-inflammatory molecule, interleukin-1 receptor antagonist, in a patient's serum for autologous treatment of inflammation. This study systematically reviews the literature for articles investigating the effectiveness of ACS in improving pain, disability, and quality of life in patients with spinal pathology.
