Research Article Fluoroscopy Assisted Minimally Invasive Transplantation of Allogenic Mesenchymal Stromal Cells Embedded in HyStem Reduces the Progression of Nucleus Pulposus Degeneration in the Damaged Interverbal Disc: A Preliminary Study in Rabbits Rifa Aquidah Subhan, 1 Karunanithi Puvanan, 1 Malliga Raman Murali, 1 Hanumantha Rao Balaji Raghavendran, 1 Samuel Shani, 1 Basri Johan Jeet Abdullah, 2 Azlina Amir Abbas, 1 Jamal Azmi Mohamed, 1 and Tunku Kamarul 1 1 Tissue Engineering Group, NOCERAL, Department of Orthopaedic Surgery, Faculty of Medicine, University of Malaya, 50603 Kuala Lumpur, Malaysia 2 Department of Biomedical Imaging, Faculty of Medicine Building, University of Malaya, 50603 Kuala Lumpur, Malaysia Correspondence should be addressed to Tunku Kamarul; tkzrea@yahoo.com Received 8 January 2014; Accepted 17 February 2014; Published 30 March 2014 Academic Editors: R. Plugmacher and H. Zhang Copyright © 2014 Rifa Aquidah Subhan et al. his is an open access article distributed under the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited. his study was conducted to develop a technique for minimally invasive and accurate delivery of stem cells to augment nucleus pulposus (NP) in damaged intervertebral discs (IVD). IVD damage was created in noncontiguous discs at L4-L5 level; rabbits (= 12) were randomly divided into three groups: group I treated with MSCs in HyStem hydrogel, group II treated with HyStem alone, and group III received no intervention. MSCs and hydrogel were administered to the damaged disc under guidance of luoroscopy. Augmentation of NP was assessed through histological and MRI T2 mapping of the NP ater eight weeks of transplantation. T2 weighted signal intensity was higher in group I than in groups II and III ( < 0.05). Disc height index showed maximum disc height in group I compared to groups II and III. Histological score of the degenerative index was signiicantly ( < 0.05) lower in group I (8.6 ± 1.8) than that in groups II (11.6 ± 2.3) and III (18.0 ± 5.7). Immunohistochemistry staining for collagen type II and aggrecan staining were higher in group I as compared to other groups. Our results demonstrate that the minimally invasive administration of MSCs in hyaluronan hydrogel (HyStem) augments the repair of NP in damaged IVD. 1. Introduction Intervertebral disc (IVD) degeneration is a complex process that produces an accelerated unfavorable, adverse efect on IVD morphology, histology, and function in many patients with chronic back pain [1, 2]. It continues to be a major cause of low back pain, incapacitating the function of any individual, which when let uncorrected not only leads to signiicant morbidity but also results in substantial economic burden [3]. In recent years the trend of treating IVD has shited from treating it symptomatically using pharmaceu- tical agents, various instrumentations, or fusion to a more curative alternative such as disc replacements. hese were done with the aim of rejuvenating the damaged disc tissue and providing long-term sustainable outcome for patients [4]. Unfortunately, many studies have demonstrated that the use of such treatments resulted in many complications in addi- tion to limiting the life span [5]. Hence, the current research has been focused on inding better alternatives among which the use of biological methods to repair degenerated IVDs Hindawi Publishing Corporation e Scientific World Journal Volume 2014, Article ID 818502, 11 pages http://dx.doi.org/10.1155/2014/818502