Human Umbilical Cord Tissue Allografts for Cervical Paraspinal Muscle and Entheses
Main Article Content
Abstract
Introduction: Cervical paraspinal enthesopathy is characterized by fatty infiltration and muscle degeneration; current methods only provide symptomatic relief or involve significant postoperative complications. This observational study provides preliminary results for the clinical potential of umbilical cord tissue allografts (UCTa) in patients with cervical paraspinal enthesopathy and degeneration refractory to standard care. Materials and Methods: Thirty-one patients with cervical paraspinal degeneration that failed three months of conservative care were identified from the observational repository. Patients received one to three ultrasound-guided UCTa applications to the muscle or attachment sites with damage. The Numeric Pain Rating Scale (NPRS), Western Ontario and McMaster University Arthritis Index (WOMAC), and Quality of Life Scale (QOLS) were used to measure outcomes. The Wilcoxon Signed-Rank test (WSRT), Mann-Whitney U test, and Jonckheere-Terpstra (J-T) test were performed for the analysis. Results: Substantial percentage improvements were observed from the patient cohort (42% male, 55% female, 3% unreported), with the triple application group reporting the highest percentage improvement. Statistically significant Bonferroni-adjusted differences were present in all application groups. No adverse events were reported. Discussion: This small observational study provides preliminary findings that UCTas are a safe, minimally invasive application for cervical paraspinal defects. Notable limitations included a lack of a direct comparison group and a small sample size. Conclusion: This study highlights the need and clinical value for continued research to validate the preliminary results for the safety, feasibility, and efficacy of umbilical cord tissue allografts in patients with cervical paraspinal defects.
Article Details
How to Cite
TAMEA, Conrad et al.
Human Umbilical Cord Tissue Allografts for Cervical Paraspinal Muscle and Entheses.
Medical Research Archives, [S.l.], v. 14, n. 6, july 2026.
ISSN 2375-1924.
Available at: <https://esmed.org/MRA/mra/article/view/7650>. Date accessed: 23 july 2026.
doi: https://doi.org/10.18103/mra.2026.0299.
Keywords
Cervical Paraspinal Muscles, Cervical Enthesopathy, Fatty Infiltration, Cervical Paraspinal Degeneration, Umbilical Cord Tissue, Umbilical Cord Tissue Allografts, Regenerative Medicine
Section
Research Articles
The Medical Research Archives grants authors the right to publish and reproduce the unrevised contribution in whole or in part at any time and in any form for any scholarly non-commercial purpose with the condition that all publications of the contribution include a full citation to the journal as published by the Medical Research Archives.
References
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17. Hauser RA, Matias D, Rawlings B. The ligamentous cervical instability etiology of human disease from the forward head-facedown lifestyle: emphasis on obstruction of fluid flow into and out of the brain. Front Neurol. 2024;15:1430390. Published 2024 Nov 27. doi:10.3389/fneur.2024.1430390
18. Suo M, Zhang J, Sun T, et al. The association between morphological characteristics of paraspinal muscle and spinal disorders. Ann Med. 2023;55(2):2258922. doi:10.1080/07853890.2023.2258922
19. Lauweryns P. Role of conservative treatment of cervical spine injuries. Eur Spine J. 2010;19 Suppl 1(Suppl 1):S23-S26. doi:10.1007/s00586-009-1116-4
20. Pillastrini P, Castellini G, Chiarotto A, et al. Comparative effectiveness of conservative and pharmacological interventions for chronic non-specific neck pain: Protocol of a systematic review and network meta-analysis. Medicine (Baltimore). 2019;98(33):e16762. doi:10.1097/MD.0000000000016762
21. Cefalì A, Santini D, Lopez G, Maselli F, Rossettini G, Crestani M, Lullo G, Young I, Dunning J, de Abreu RM, et al. Effects of Breathing Exercises on Neck Pain Management: A Systematic Review with Meta-Analysis. Journal of Clinical Medicine. 2025; 14(3):709. https://doi.org/10.3390/jcm14030709
22. Adapa N, Jain N, Capek A, et al. Prophylactic muscle flap reconstruction after complex spine surgery for degenerative disease: case series and institutional protocol. J Spine Surg. 2018;4(3):560-567. doi:10.21037/jss.2018.07.04
23. Roy A, Mantay M, Brannan C, Griffiths S. Placental Tissues as Biomaterials in Regenerative Medicine. Biomed Res Int. 2022;2022:6751456. doi:10.1155/2022/6751456
24. Main BJ, Maffulli N, Valk JA, Rodriguez HC, Gupta M, El-Amin SF III, Gupta A. Umbilical Cord-Derived umbilical cord tissue for Regenerative Medicine Applications: A Systematic Review. Pharmaceuticals. 2021; 14(11):1090. https://doi.org/10.3390/ph14111090
25. Lai A, Tamea C, Shou J, Okafor A, Sparks J, Dodd R, Woods C, Lambert N, Schulte O, Barrett T. Safety and Efficacy of umbilical cord tissue Connective Tissue Allograft for Rotator Cuff Tears: Findings from a Retrospective Observational Study. Biomedicines. 2024; 12(4):710. https://doi.org/10.3390/biomedicines12040710
26. Lai A, Tamea C, Shou J, Okafor A, Sparks J, Dodd R, Lambert N, Woods C, Schulte O, Kovar S, et al. Retrospective Evaluation of Cryopreserved Human Umbilical Cord Tissue Allografts in the Supplementation of Cartilage Defects Associated with Hip Osteoarthritis. Journal of Clinical Medicine. 2024; 13(14):4040. https://doi.org/10.3390/jcm13144040
27. Seigerman D, McEntee RM, Matzon J, et al. Time to Improvement After Corticosteroid Injection for Trigger Finger. Cureus. 2021;13(8):e16856. Published 2021 Aug 3. doi:10.7759/cureus.16856
28. Allen S Chen, Joseph Solberg, Clark Smith, Michelle Chi, Ryan Lowder, George Christolias, Jaspal Ricky Singh, Intra-Articular Platelet Rich Plasma vs Corticosteroid Injections for Sacroiliac Joint Pain: A Double-Blinded, Randomized Clinical Trial, Pain Medicine, Volume 23, Issue 7, July 2022, Pages 1266–1271, https://doi.org/10.1093/pm/pnab332
29. Navani A, Ambach M, Calodney A, Rosenthal R, Li G, Mahoney CB, Everts PA. The Safety and Effectiveness of Orthobiologic Injections for Discogenic Chronic Low Back Pain: A Multicenter Prospective, Crossover, Randomized Controlled Trial with 12 Months Follow-up. Pain Physician. 2024 Jan;27(1):E65-E77. PMID: 38285032.
30. Tamea C, Buchalter J, Capra J, Gilliland T, Lambert N, Lee A, Barrett T. An Observational Study of Human Umbilical Cord Tissue Allografts for Paraspinal Muscle and Entheses Defects in the Thoracic and Lumbar Regions. Biomedicines. 2026; 14(5):1030. https://doi.org/10.3390/biomedicines14051030
31. Davis JM, Purita JR, Shou J, Barrett TC. Three-Dimensional Electron Microscopy of Human Umbilical Cord Tissue Allograft Pre and Post Processing: A Literature Comparison. J Biomed Res Environ Sci. 2022 Aug 15; 3(8): 934-940. doi: 10.37871/ jbres1535, Article ID: JBRES1535, Available at: https://www.jelsciences.com/articles/jbres1535.pdf
32. Park SH, Kang BH, Kim MJ, et al. Validation of the Western Ontario and McMaster Universities Arthritis Index Short Form (WOMAC-SF) and Its Relevance to Disability and Frailty. Yonsei Med J. 2020;61(3):251-256. doi:10.3349/ymj.2020.61.3.251
33. Wohlgemuth RP, Brashear SE, Smith LR. Alignment, cross linking, and beyond: a collagen architect's guide to the skeletal muscle extracellular matrix. Am J Physiol Cell Physiol. 2023;325(4):C1017-C1030. doi:10.1152/ajpcell.00287.2023
34. Csapo R, Gumpenberger M, Wessner B. Skeletal Muscle Extracellular Matrix - What Do We Know About Its Composition, Regulation, and Physiological Roles? A Narrative Review. Front Physiol. 2020;11:253. Published 2020 Mar 19. doi:10.3389/fphys.2020.00253
35. Apostolakos J, Durant TJ, Dwyer CR, Russell RP, Weinreb JH, Alaee F, Beitzel K, McCarthy MB, Cote MP, Mazzocca AD. The enthesis: a review of the tendon-to-bone insertion. Muscles Ligaments Tendons J. 2014 Nov 17;4(3):333-42. PMID: 25489552; PMCID: PMC4241425.
36. Tits A, Blouin S, Rummler M, et al. Structural and functional heterogeneity of mineralized fibrocartilage at the Achilles tendon-bone insertion. Acta Biomater. 2023;166:409-418. doi:10.1016/j.actbio.2023.04.018
37. Dubus M, Scomazzon L, Chevrier J, et al. Decellularization of umbilical cord tissue Increases Its Bioactivity and Antibacterial Properties. Front Bioeng Biotechnol. 2022;10:828424. doi:10.3389/fbioe.2022.828424
38. Masiello F, Pati I, Veropalumbo E, Pupella S, Cruciani M, De Angelis V. Ultrasound-guided injection of platelet-rich plasma for tendinopathies: a systematic review and meta-analysis. Blood Transfus. 2023;21(2):119-136. doi:10.2450/2022.0087-22
39. Rahman E, Rao P, Abu-Farsakh HN, Thonse C, Ali I, Upton AE, Baratikkae SY, Carruthers JDA, Mosahebi A, Heidari N, et al. Systematic Review of Platelet-Rich Plasma in Medical and Surgical Specialties: Quality, Evaluation, Evidence, and Enforcement. Journal of Clinical Medicine. 2024; 13(15):4571. https://doi.org/10.3390/jcm13154571
40. Boffa A, De Marziani L, Andriolo L, et al. Influence of Platelet Concentration on the Clinical Outcome of Platelet-Rich Plasma Injections in Knee Osteoarthritis. Am J Sports Med. 2024;52(13):3223-3231. doi:10.1177/03635465241283463
41. Thamrongskulsiri N, Vitoonpong T, Itthipanichpong T, Limskul D, Tanpowpong T, Kuptniratsaikul S. Prolotherapy is not superior to control or placebo-based conservative treatments for rotator cuff tendinopathy: a systematic review and meta-analysis. Clin Shoulder Elb. 2025;28(4):446-456. doi:10.5397/cise.2025.00570
2. Kim R, Wiest C, Clark K, Cook C, Horn M. Identifying risk factors for first-episode neck pain: A systematic review. Musculoskelet Sci Pract. 2018;33:77-83. doi:10.1016/j.msksp.2017.11.007
3. GBD 2021 Neck Pain Collaborators. Global, regional, and national burden of neck pain, 1990-2020, and projections to 2050: a systematic analysis of the Global Burden of Disease Study 2021. Lancet Rheumatol. 2024;6(3):e142-e155. doi:10.1016/S2665-9913(23)00321-1
4. Hou X, Lu S, Wang B, Kong C, Hu H. Morphologic Characteristics of the Deep Cervical Paraspinal Muscles in Patients with Single-Level Cervical Spondylotic Myelopathy. World Neurosurg. 2020;134:e166-e171. doi:10.1016/j.wneu.2019.09.162
5. Liao Y, Lin X, Su W, et al. MRI-based assessment paraspinal extensor muscle fatty infiltration in acute cervical spinal cord injury patients - a retrospective study. BMC Musculoskelet Disord. 2024;25(1):702. Published 2024 Sep 3. doi:10.1186/s12891-024-07808-0
6. Tamai K, Grisdela P Jr, Romanu J, et al. The Impact of Cervical Spinal Muscle Degeneration on Cervical Sagittal Balance and Spinal Degenerative Disorders. Clin Spine Surg. 2019;32(4):E206-E213. doi:10.1097/BSD.0000000000000789
7. De Pauw R, Coppieters I, Kregel J, De Meulemeester K, Danneels L, Cagnie B. Does muscle morphology change in chronic neck pain patients? - A systematic review. Man Ther. 2016;22:42-49. doi:10.1016/j.math.2015.11.006
8. Zhu Y, Hu Y, Pan Y, et al. Fatty infiltration in the musculoskeletal system: pathological mechanisms and clinical implications. Front Endocrinol (Lausanne). 2024;15:1406046. Published 2024 Jun 28. doi:10.3389/fendo.2024.1406046
9. Anderson B, Ordaz A, Zlomislic V, et al. Paraspinal Muscle Health is Related to Fibrogenic, Adipogenic, and Myogenic Gene Expression in Patients with Lumbar Spine Pathology. BMC Musculoskelet Disord. 2022;23(1):608. Published 2022 Jun 24. doi:10.1186/s12891-022-05572-7
10. Ordaz A, Anderson B, Zlomislic V, et al. Paraspinal muscle gene expression across different aetiologies in individuals undergoing surgery for lumbar spine pathology. Eur Spine J. 2023;32(4):1123-1131. doi:10.1007/s00586-023-07543-5
11. Yang X, Guo L, Shu J. Unveiling the Potential Mechanism of Asymmetric Fat Infiltration in Paraspinal Muscles of Adult Degenerative Scoliosis: The Role of the Hsa_circ_0006156/miR-122-5p/PPARA Regulatory Network. JOR Spine. 2025;8(4):e70146. Published 2025 Nov 30. doi:10.1002/jsp2.70146
12. He J, Wu T, Ding C, Wang B, Hong Y, Liu H. The fatty infiltration into cervical paraspinal muscle as a predictor of postoperative outcomes: A controlled study based on hybrid surgery. Front Endocrinol (Lausanne). 2023;14:1128810. Published 2023 Feb 9. doi:10.3389/fendo.2023.1128810
13. Huber FA, Del Grande F, Rizzo S, Guglielmi G, Guggenberger R. MRI in the assessment of adipose tissues and muscle composition: how to use it. Quant Imaging Med Surg. 2020;10(8):1636-1649. doi:10.21037/qims.2020.02.06
14. Toto-Brocchi M, Wu Y, Jerban S, et al. Quantitative ultrasound assessment of fatty infiltration of the rotator cuff muscles using backscatter coefficient. Eur Radiol Exp. 2024;8(1):119. Published 2024 Oct 22. doi:10.1186/s41747-024-00522-5
15. Sudoł-Szopińska I, Kwiatkowska B, Prochorec-Sobieszek M, Maśliński W. Enthesopathies and enthesitis. Part 1. Etiopathogenesis. J Ultrason. 2015;15(60):72-84. doi:10.15557/JoU.2015.0006
16. Kumar Varma Kalidindi K, Sharma JK, Vishwakarma G, Duggi S, Chhabra HS. Ligamentum Flavum Buckling vs Hypertrophy in Cervical Myelopathy Using Dynamic Imaging: Are Instability and Loss of Disc Height the Culprits?. Int J Spine Surg. 2022;16(2):300-308. doi:10.14444/8221
17. Hauser RA, Matias D, Rawlings B. The ligamentous cervical instability etiology of human disease from the forward head-facedown lifestyle: emphasis on obstruction of fluid flow into and out of the brain. Front Neurol. 2024;15:1430390. Published 2024 Nov 27. doi:10.3389/fneur.2024.1430390
18. Suo M, Zhang J, Sun T, et al. The association between morphological characteristics of paraspinal muscle and spinal disorders. Ann Med. 2023;55(2):2258922. doi:10.1080/07853890.2023.2258922
19. Lauweryns P. Role of conservative treatment of cervical spine injuries. Eur Spine J. 2010;19 Suppl 1(Suppl 1):S23-S26. doi:10.1007/s00586-009-1116-4
20. Pillastrini P, Castellini G, Chiarotto A, et al. Comparative effectiveness of conservative and pharmacological interventions for chronic non-specific neck pain: Protocol of a systematic review and network meta-analysis. Medicine (Baltimore). 2019;98(33):e16762. doi:10.1097/MD.0000000000016762
21. Cefalì A, Santini D, Lopez G, Maselli F, Rossettini G, Crestani M, Lullo G, Young I, Dunning J, de Abreu RM, et al. Effects of Breathing Exercises on Neck Pain Management: A Systematic Review with Meta-Analysis. Journal of Clinical Medicine. 2025; 14(3):709. https://doi.org/10.3390/jcm14030709
22. Adapa N, Jain N, Capek A, et al. Prophylactic muscle flap reconstruction after complex spine surgery for degenerative disease: case series and institutional protocol. J Spine Surg. 2018;4(3):560-567. doi:10.21037/jss.2018.07.04
23. Roy A, Mantay M, Brannan C, Griffiths S. Placental Tissues as Biomaterials in Regenerative Medicine. Biomed Res Int. 2022;2022:6751456. doi:10.1155/2022/6751456
24. Main BJ, Maffulli N, Valk JA, Rodriguez HC, Gupta M, El-Amin SF III, Gupta A. Umbilical Cord-Derived umbilical cord tissue for Regenerative Medicine Applications: A Systematic Review. Pharmaceuticals. 2021; 14(11):1090. https://doi.org/10.3390/ph14111090
25. Lai A, Tamea C, Shou J, Okafor A, Sparks J, Dodd R, Woods C, Lambert N, Schulte O, Barrett T. Safety and Efficacy of umbilical cord tissue Connective Tissue Allograft for Rotator Cuff Tears: Findings from a Retrospective Observational Study. Biomedicines. 2024; 12(4):710. https://doi.org/10.3390/biomedicines12040710
26. Lai A, Tamea C, Shou J, Okafor A, Sparks J, Dodd R, Lambert N, Woods C, Schulte O, Kovar S, et al. Retrospective Evaluation of Cryopreserved Human Umbilical Cord Tissue Allografts in the Supplementation of Cartilage Defects Associated with Hip Osteoarthritis. Journal of Clinical Medicine. 2024; 13(14):4040. https://doi.org/10.3390/jcm13144040
27. Seigerman D, McEntee RM, Matzon J, et al. Time to Improvement After Corticosteroid Injection for Trigger Finger. Cureus. 2021;13(8):e16856. Published 2021 Aug 3. doi:10.7759/cureus.16856
28. Allen S Chen, Joseph Solberg, Clark Smith, Michelle Chi, Ryan Lowder, George Christolias, Jaspal Ricky Singh, Intra-Articular Platelet Rich Plasma vs Corticosteroid Injections for Sacroiliac Joint Pain: A Double-Blinded, Randomized Clinical Trial, Pain Medicine, Volume 23, Issue 7, July 2022, Pages 1266–1271, https://doi.org/10.1093/pm/pnab332
29. Navani A, Ambach M, Calodney A, Rosenthal R, Li G, Mahoney CB, Everts PA. The Safety and Effectiveness of Orthobiologic Injections for Discogenic Chronic Low Back Pain: A Multicenter Prospective, Crossover, Randomized Controlled Trial with 12 Months Follow-up. Pain Physician. 2024 Jan;27(1):E65-E77. PMID: 38285032.
30. Tamea C, Buchalter J, Capra J, Gilliland T, Lambert N, Lee A, Barrett T. An Observational Study of Human Umbilical Cord Tissue Allografts for Paraspinal Muscle and Entheses Defects in the Thoracic and Lumbar Regions. Biomedicines. 2026; 14(5):1030. https://doi.org/10.3390/biomedicines14051030
31. Davis JM, Purita JR, Shou J, Barrett TC. Three-Dimensional Electron Microscopy of Human Umbilical Cord Tissue Allograft Pre and Post Processing: A Literature Comparison. J Biomed Res Environ Sci. 2022 Aug 15; 3(8): 934-940. doi: 10.37871/ jbres1535, Article ID: JBRES1535, Available at: https://www.jelsciences.com/articles/jbres1535.pdf
32. Park SH, Kang BH, Kim MJ, et al. Validation of the Western Ontario and McMaster Universities Arthritis Index Short Form (WOMAC-SF) and Its Relevance to Disability and Frailty. Yonsei Med J. 2020;61(3):251-256. doi:10.3349/ymj.2020.61.3.251
33. Wohlgemuth RP, Brashear SE, Smith LR. Alignment, cross linking, and beyond: a collagen architect's guide to the skeletal muscle extracellular matrix. Am J Physiol Cell Physiol. 2023;325(4):C1017-C1030. doi:10.1152/ajpcell.00287.2023
34. Csapo R, Gumpenberger M, Wessner B. Skeletal Muscle Extracellular Matrix - What Do We Know About Its Composition, Regulation, and Physiological Roles? A Narrative Review. Front Physiol. 2020;11:253. Published 2020 Mar 19. doi:10.3389/fphys.2020.00253
35. Apostolakos J, Durant TJ, Dwyer CR, Russell RP, Weinreb JH, Alaee F, Beitzel K, McCarthy MB, Cote MP, Mazzocca AD. The enthesis: a review of the tendon-to-bone insertion. Muscles Ligaments Tendons J. 2014 Nov 17;4(3):333-42. PMID: 25489552; PMCID: PMC4241425.
36. Tits A, Blouin S, Rummler M, et al. Structural and functional heterogeneity of mineralized fibrocartilage at the Achilles tendon-bone insertion. Acta Biomater. 2023;166:409-418. doi:10.1016/j.actbio.2023.04.018
37. Dubus M, Scomazzon L, Chevrier J, et al. Decellularization of umbilical cord tissue Increases Its Bioactivity and Antibacterial Properties. Front Bioeng Biotechnol. 2022;10:828424. doi:10.3389/fbioe.2022.828424
38. Masiello F, Pati I, Veropalumbo E, Pupella S, Cruciani M, De Angelis V. Ultrasound-guided injection of platelet-rich plasma for tendinopathies: a systematic review and meta-analysis. Blood Transfus. 2023;21(2):119-136. doi:10.2450/2022.0087-22
39. Rahman E, Rao P, Abu-Farsakh HN, Thonse C, Ali I, Upton AE, Baratikkae SY, Carruthers JDA, Mosahebi A, Heidari N, et al. Systematic Review of Platelet-Rich Plasma in Medical and Surgical Specialties: Quality, Evaluation, Evidence, and Enforcement. Journal of Clinical Medicine. 2024; 13(15):4571. https://doi.org/10.3390/jcm13154571
40. Boffa A, De Marziani L, Andriolo L, et al. Influence of Platelet Concentration on the Clinical Outcome of Platelet-Rich Plasma Injections in Knee Osteoarthritis. Am J Sports Med. 2024;52(13):3223-3231. doi:10.1177/03635465241283463
41. Thamrongskulsiri N, Vitoonpong T, Itthipanichpong T, Limskul D, Tanpowpong T, Kuptniratsaikul S. Prolotherapy is not superior to control or placebo-based conservative treatments for rotator cuff tendinopathy: a systematic review and meta-analysis. Clin Shoulder Elb. 2025;28(4):446-456. doi:10.5397/cise.2025.00570