**2.8 Spondylosis**

Cervical and lumbar spondylosis represent the constellation of degenerative changes found in the cervical and lumbar spine that progressively occur in most people with aging. 25% of people under 40 years of age, 50% of people over 40 years of age, and 85% of people over 60 years of age are estimated to have cervical spondylosis [45]. Pathologically, the same degenerative processes that characterize OA extend to the vertebral joints and result in spondylosis often characterized by disc degeneration, uncinate spurring and facet arthrosis, ligamentous thickening and infolding, and deformity. Radiculopathy, myelopathy, discogenic pain, facet pain are the clinical manifestations of vertebral joint degeneration. Regenerative techniques for the treatment of cervical and lumbar spondylosis has been previously investigated with promising results. Further studies are needed to weigh safety profiles against efficacy. In an RCT of PRP vs. contrast for discogenic pain, Tuakli-Wosornu et al., reported significant improvements in pain and function at

8-week follow-up [46]. Pettine et al. reported significant reductions in pain following BMAC use for patients with discogenic pain [47]. The principle caveat of these results is the scarcity of similar results demonstrated in the literature [48].

#### **2.9 Tendon and ligament healing**

Tendon and ligament injuries are a very common cause of pain and disability, among both the very active and the elderly. Lateral epicondylitis is significantly more common among working-age patients with physical workloads [49]. As much as 80% of patients over 80 years of age are estimated to have a rotator cuff tear [50]. The use of PRP for tendon and ligament healing has mixed reviews but is considered by many a viable treatment modality given low risks of severe associated complications and numerous positive results promulgated throughout the literature. In a meta-analysis of 21 studies comparing PRP to control (betamethasone with lignocaine, saline, corticosteroid, bupivacaine, and whole blood), Chen et al. found PRP significantly associated with short-term (2–6.5 months) improvements in VAS scores among patients with rotator cuff injuries (p < 0.01) and lateral epicondylitis (p < 0.01) and long-term pain control among patients with rotator cuff injuries (p = 0.02), lateral epicondylitis (p = 0.01), and tendinopathy (p < 0.01) [40]. Evidence describing the clinical utility of MSCs and BMACs a in tendon and ligament injuries is lacking and mostly limited to *in vitro* and *in vivo* studies [51, 52].

#### **2.10 Future therapy**

Many experimental trials continue to assess the role of these injectates in tissue repair of the central nervous system (CNS), cardiovascular system, hepatic, renal as well as musculoskeletal system [2]. Some studies demonstrate exosomal induced neural cell growth while others have explored with success the use of exosomes as a promising potential treatment option for Alzheimer's disease and other neurodegenerative pathologies. Others demonstrate the ability of exosomes to differentiate into bone tissue and promote skeletal regeneration [53].

Additionally, regenerative therapies such as PRP have shown a lot of promise in dermatology including prevention of hair loss, the treatment of scars and post procedure recovery, skin rejuvenation, dermal augmentation, and the treatment of striae distensae [54, 55]. Despite the lack of insurance coverage, these therapeutic modalities show much promise in the innovative world of medicine and esthetics.

### **3. Conclusion**

These various injectates present a novel and promising treatment for many degenerative conditions including neurological and musculoskeletal diseases. Not only can biologics relieve symptoms in painful conditions, but also they can halt the degeneration of tissues, regenerate tissue and prolong their lifespan. PRP, MSC's, and exosomes have made considerable progress and will therefore undoubtedly offer new and exciting prospects for a variety of musculoskeletal and nervous system conditions. Their utility in conditions such as osteoarthritis, spondylosis, and tendon and ligamentous injuries are gaining popularity with emerging clinical reports of their efficacy.

The thought that tissue repair and regeneration was a function of the MSCs themselves is now shifting toward the thinking that, exosomes, secreted by MSCs have a more direct role in the process. These exosomes can have a different effect depending on the differentiation state of the tissue from which they are extracted.

**27**

**Author details**

Armen Haroutunian1

\*, Tennison Malcolm<sup>2</sup>

3 Texas Tech University Health Sciences Center, Lubbock, Texas, USA

© 2020 The Author(s). Licensee IntechOpen. This chapter is distributed under the terms of the Creative Commons Attribution License (http://creativecommons.org/licenses/ by/3.0), which permits unrestricted use, distribution, and reproduction in any medium,

1 University of California Los Angeles, Los Angeles, CA, USA

2 Brigham and Women's Hospital, Boston, MA, USA

\*Address all correspondence to: armenh12@gmail.com

provided the original work is properly cited.

and Thomas Zouki3

*Regenerative Medicine*

*DOI: http://dx.doi.org/10.5772/intechopen.93717*

extents of their roles in degenerative conditions.

They exert their function by communicating in a paracrine fashion with the surrounding tissue and initiate a process of cellular differentiation and proliferation, playing an important role in tissue repair. The use of exosomes shows promising results in disease processes that have no current available treatment. The use of biologic injectates for painful conditions deserves further consideration. Large, well-constructed studies are needed to better understand their applications and

#### *Regenerative Medicine DOI: http://dx.doi.org/10.5772/intechopen.93717*

*Pain Management - Practices, Novel Therapies and Bioactives*

**2.9 Tendon and ligament healing**

**2.10 Future therapy**

**3. Conclusion**

reports of their efficacy.

8-week follow-up [46]. Pettine et al. reported significant reductions in pain following BMAC use for patients with discogenic pain [47]. The principle caveat of these

Tendon and ligament injuries are a very common cause of pain and disability, among both the very active and the elderly. Lateral epicondylitis is significantly more common among working-age patients with physical workloads [49]. As much as 80% of patients over 80 years of age are estimated to have a rotator cuff tear [50]. The use of PRP for tendon and ligament healing has mixed reviews but is considered by many a viable treatment modality given low risks of severe associated complications and numerous positive results promulgated throughout the literature. In a meta-analysis of 21 studies comparing PRP to control (betamethasone with lignocaine, saline, corticosteroid, bupivacaine, and whole blood), Chen et al. found PRP significantly associated with short-term (2–6.5 months) improvements in VAS scores among patients with rotator cuff injuries (p < 0.01) and lateral epicondylitis (p < 0.01) and long-term pain control among patients with rotator cuff injuries (p = 0.02), lateral epicondylitis (p = 0.01), and tendinopathy (p < 0.01) [40]. Evidence describing the clinical utility of MSCs and BMACs a in tendon and ligament injuries is lacking and mostly limited to *in vitro* and *in vivo* studies [51, 52].

Many experimental trials continue to assess the role of these injectates in tissue repair of the central nervous system (CNS), cardiovascular system, hepatic, renal as well as musculoskeletal system [2]. Some studies demonstrate exosomal induced neural cell growth while others have explored with success the use of exosomes as a promising potential treatment option for Alzheimer's disease and other neurodegenerative pathologies. Others demonstrate the ability of exosomes to differentiate

Additionally, regenerative therapies such as PRP have shown a lot of promise in dermatology including prevention of hair loss, the treatment of scars and post procedure recovery, skin rejuvenation, dermal augmentation, and the treatment of striae distensae [54, 55]. Despite the lack of insurance coverage, these therapeutic modalities show much promise in the innovative world of medicine and esthetics.

These various injectates present a novel and promising treatment for many degenerative conditions including neurological and musculoskeletal diseases. Not only can biologics relieve symptoms in painful conditions, but also they can halt the degeneration of tissues, regenerate tissue and prolong their lifespan. PRP, MSC's, and exosomes have made considerable progress and will therefore undoubtedly offer new and exciting prospects for a variety of musculoskeletal and nervous system conditions. Their utility in conditions such as osteoarthritis, spondylosis, and tendon and ligamentous injuries are gaining popularity with emerging clinical

The thought that tissue repair and regeneration was a function of the MSCs themselves is now shifting toward the thinking that, exosomes, secreted by MSCs have a more direct role in the process. These exosomes can have a different effect depending on the differentiation state of the tissue from which they are extracted.

into bone tissue and promote skeletal regeneration [53].

results is the scarcity of similar results demonstrated in the literature [48].

**26**

They exert their function by communicating in a paracrine fashion with the surrounding tissue and initiate a process of cellular differentiation and proliferation, playing an important role in tissue repair. The use of exosomes shows promising results in disease processes that have no current available treatment. The use of biologic injectates for painful conditions deserves further consideration. Large, well-constructed studies are needed to better understand their applications and extents of their roles in degenerative conditions.
