A 59-year-old male presented to a tertiary care center with a two-month history of worsening lower back pain. Two months prior to presentation, the patient had gone to Mexico and received multiple stem cell injections from donor placenta into the lumbar intervertebral disc at multiple levels for degenerative disc disease. Since these injections, his back pain had progressively worsened. A MRI was performed and revealed L3-L5 epidural/paravertebral abscess with discitis and osteomyelitis (Figure 1). The patient was empirically started on vancomycin 1 g IV q 12 hours and cefipime 2 g IV q 12 hours. When bone biopsy culture results were positive for candida parapsilosis, the patient was started on fluconazole 800 mg PO daily. A gallium scan showed increased uptake in the lumbar spine region. An L2-L5 laminectomy and I&D were performed by neurosurgery. Following surgery, the patient was transferred to a rehabilitation unit and remained on antibiotics for six weeks. Fluconazole was continued for one year. Follow-up MRI and gallium scan one year after discharge verified infection resolution (Figure 2).

Degenerative disc disease (DDD) is a common cause of low back pain. Therefore, regeneration strategies aimed at restoring the disc extracellular matrix and height have been proposed as potential treatments for DDD. There have been many studies that investigated the potential of stem cells for treatment of DDD. [1] [2] Even though there is promise in this treatment modality, the optimum method for stem cell usage is still unclear.[3] Despite this uncertainty, stem cell injections have been available for purchase in the global health marketplace in recent years.[4] Mexico has been leading the flourishing stem cell industry, treating chronic discogenic pain from DDD, cerebral palsy, autism, and paralysis with donor placenta.[5]

This rare case report demonstrates imaging from the catastrophic complications that can result from stem cell injections into the intervertebral discs and that medical tourism is extremely risky for this procedure, especially when there is insufficient evidence at this time regarding the efficacy of the procedure.

1. Richardson SM, Hoyland JA. Stem cell regeneration of degenerated intervertebral discs: current status. Curr Pain Headache Rep 2008 Apr;12(2):83–8.   [CrossRef]   [Pubmed]    
2. Sobajima S, Vadala G, Shimer A, Kim JS, Gilbertson LG, Kang JD. Feasibility of a stem cell therapy for intervertebral disc degeneration. Spine J 2008 Nov-Dec;8(6):888–96.   [CrossRef]   [Pubmed]    
3. Freemont TJ, LeMaitre C, Watkins A, Hoyland JA. Degeneration of intervertebral discs: current understanding of cellular and molecular events, and implications for novel therapies. Expert Rev Mol Med 2001 Mar 29;2001:1–10.   [CrossRef]   [Pubmed]    
4. Turner L. "Medical tourism, and the global marketplace in health services: US patients, international hospitals, and the search for affordable health care". Int J Health Serv 2010;40(3):443–67.   [CrossRef]   [Pubmed]    
5. Dhar D, Hsi-En Ho J. Stem Cell Research Policies around the World. Yale J Biol Med 2009 September;82(3):113–5.   [Pubmed]