A spinal examination is being carried out at a clinic south of Sydney. On the table is Kylie Stewart, who is suffering from severe lower back pain.
“I have two bulging discs in my lower back,” says Stewart, 38.
“It’s quite debilitating. I can’t exercise, I’ve pretty much given up. I used to run a lot. Of course I can’t do that anymore.
“I just feel old and inadequate and upset – really, really upset.”
Kylie Stewart was once an avid runner. Source: Delivered / Kylie Stewart
Stewart is one of about four million Australians who suffer from back problems. It is estimated that the cost of treatment exceeds $3 billion annually.
Human trials of a promising technique designed to rehabilitate intervertebral discs will begin next year. Stewart is on the waiting list.
“If this works, it’s just crazy what it can do for people,” she says.
Orthopedic spine surgeon Dr. Ashish Diwan, director of the spine service in the Department of Orthopedic Surgery at St. George Hospital, is overseeing the project.
Dr. Ashish Diwan looks at images of spinal damage. Source: SBS / Spencer Austad
“Australia is leading the world in this,” says Diwan.
“This trial aims to cure an intervertebral disc injury by healing it. So we inject a recombinant protein that can mobilize the stem cells, which are located just above and below the intervertebral disc.
“And when they get to the disc, they actually become disc-like cells and heal the disc.”
The trial will start in January 2025 with an initial group of approximately twenty participants. Diwan says this number will increase to 80 people and eventually around 250 to 300 people.
Kylie Stewart (left) with Dr. Ashish Diwan (center) and researcher Nashwa Najib. Source: SBS / Spencer Austad
It receives government and financial backing from SoHi, a venture capital firm based in the Southern Highlands of NSW that specializes in biotechnology.
Diwan is one of the founders of the fund and is enthusiastic about the potential of the trial.
“First, we need to see pain relief. We have proof of that [this technique] causes pain relief, which we should see within a few weeks.
“Then we should see evidence of disk repair in the second phase. That will take about three months to six months.
“If we can save at least 50 percent of trial participants from moving toward spinal fusion, that would be a great success.”
Diwan says a commercial release could take another five years. However, these first human trials follow four years of rigorous animal testing.
“In all circumstances where there was a mechanical compression injury or a direct injury, we have shown that it heals. If there was pain it also changed.”
For Stewart, that pain is a constant. The psychiatric nurse is the mother of a teenage son and cannot think about having any more children.
“If I had another child, I wouldn’t be able to carry it. Even if I were pregnant, it would be impossible,” she says.
Dr. Ashish Diwan in consultation with Kylie Stewart. Source: SBS / Spencer Austad
Although she can still drive, she says even sitting behind the wheel is a challenge.
“It’s like a pressure in the lower part of my back, in the lumbar spine. It’s a constant pressure and I’m already anticipating how I’m going to feel when I get up. I’m constantly cringing because I know what’s going on is happening,” she says.
The disc injury occurred during recovery from knee surgery following a sports accident and during light training at the gym.
“The next day I woke up and I literally couldn’t move. It was excruciating pain and my right hip was higher than my left and I couldn’t straighten my back,” she says.
Kylie Stewart has high hopes for the trial next year. Source: SBS / Spencer Austad
Experts have offered powerful painkillers or fusion surgery, but Stewart says neither treatment appeals to her.
“It’s sad, I don’t feel like I’m in control of my life right now. I feel like there’s no hope. I always imagine that if I feel this way now, what will I feel like in ten , twenty, thirty years will feel.” time?
“How much worse will it get if I don’t get it fixed?”
A recent study from the University of Sydney, published in the Lancet Rheumatology, predicts that the number of back pain cases in Australia will increase by 50 percent by 2050.
The increase is partly due to population growth and partly to the general aging of the population.
“We have established for the first time that the peak prevalence is around 80 to 85 years of age,” said lead author, Professor Manuela Ferreira.
Professor Manuela Ferreira from the University of Sydney. Source: Delivered / Bill Green / Manuela Ferreira
Although intervertebral disc deterioration due to age is one cause, Ferreira says there are other risk factors.
“Occupational factors include work that involves vibration or standing and sitting for long periods of time, for example driving. Other factors include lifting and carrying, as well as smoking and a high BMI,” she says.
“Low back pain has been considered the leading cause of disability in the world since 1990. Our analysis paints a picture of the growing number of cases of low back pain worldwide, putting enormous pressure on our healthcare system.
“We estimate that approximately 623 million people suffer from lower back pain and by 2050 we expect that there will be 850 million people with back pain worldwide, which again is a very large number,” she says.
Dr. Nashwa Najib is a spine researcher. Source: SBS / Spencer Austad
Dr. Nashwa Najib is a spine researcher completing a PhD as part of Diwan’s team. She says this new project could have a broader impact on people with chronic conditions.
“Back pain truly affects the entire spectrum of human life, not just physical health. It affects psychological well-being, it affects financial health and also interpersonal relationships.
‘I’m sure the impact [of this trial] will be huge not only for the patients improving their overall spine health, but also for the practicing physicians. It gives them that little bit extra.”
Diwan has dedicated 25 years to spine surgery. However, he hopes that these studies will provide a viable alternative to spinal fusion.
“It will be very disruptive. It will be very satisfying. It will change the productivity of countries, it will improve people’s mental health.
“We will all walk more, run more and take less pain medication. We will enjoy family time more.”
Spine patient Stewart says her main goal is to return to what she loves.
“I literally can’t wait to start running again. I told myself I would never do a half marathon again. But if I could run, I would absolutely do another one, just because I can.”
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