Resolution of lumbar bone marrow oedema

I've been receiving pentosan treatment for my osteoarthritis of the spine (facet joint OA). I have now had two courses of pentosan injections, nearly a year apart. I had a baseline MRI done before the first treatment, and I have just had a second MRI, after two treatments.

The MRIs show the disappearance of bone marrow oedema, both in the vertebral body, and in the facet joints. There is also significant resolution of a bulging disc.

BME is like bruising in the bone, as a result of the loss of cushioning from the cartilage, which has been lost due to the OA. Its the BME that is responsible for the pain of arthritis. It also causes inflammation that fuels the further progression of the condition. The bulging disc is probably the cause of my sciatica. I have experienced significant improvement in both arthritic and sciatic pain after these two treatments.

Here are the before and after images showing the disappearance of BME in the vertebral body. The BME shows up as a white patch within the bone, which I've highlighted by an arrow:




You can see the oedema has completely disappeared.

You can also see the bulging disc has retreated back into the intervertebral space, no longer impinging as much on the spinal cord.

Moving on to the facet joint (where the spiky bits of the spine rest on each other) - the anatomy of this joint is a lot more complicated. The white stripes are the joint, or rather they're the space between the joint where the cartilage used to be. In a healthy joint it would be much darker, being filled by cartilage instead of just fluid.

So also in this joint you can see BME in each of the two mating vertebrae, on either side of the joint, before pentosan treatment. After pentosan treatment, these lesions have also resolved:




Unfortunately that cartilage is not coming back (not that it would be expected to). But the BME is now gone.

My doctor was really impressed with this result. I was the first patient he had treated for facet joint OA, and he was sceptical. But based on my experience he has now referred several other patients. Good for them. I'm also the only patient to have received a second course for spinal OA.

Why the disc bulge has reduced is hard to say. However, the disc and its structures are mainly constructed of collagen, same as cartilage, so maybe the integrity of the disc has been improved, or or has improved now the inflammation has been removed.

My own subjective experience has been extremely positive. I don't experience any significant arthritic or sciatic pain. This in turn has the downstream that I am able to do conditioning training that builds my core strength, which will stabilise the spine and help prevent progression of the condition.

For the sake of clarity I try to write about these things in a dispassionate and objective way. But don't be fooled - I am super excited about this! This is a really dramatic outcome, both in terms of the pathology, and the impact it has had for me personally. I am able to sustain high training volume and high training loads and high flexibility. I recognize that OA is a progressive condition, so I am treating this as a window of opportunity to to build a really strong core which, on top of the direct effect of pentosan will help prevent a relapse.

And of course it confirms my confidence in the product, and its inevitable path to mass adoption in the clinic.