Intradiscal Injection of Adinizer-Processed Minimally Microfragmented Adipose Tissue for Degenerative Lumbar Spondylolisthesis: A Case Report With a Two-Year Follow-Up.

Degenerative lumbar spondylolisthesis is a common cause of chronic low back pain and functional limitation in older adults. Although conservative treatment is generally considered first-line management, some patients continue to experience persistent symptoms, and surgery may not always be feasible or acceptable. We report the two-year clinical course of a 72-year-old woman with symptomatic degenerative lumbar spondylolisthesis who underwent intradiscal injection of Adinizer-processed minimally microfragmented adipose tissue (MFAT). She had longstanding chronic low back pain for approximately six years, with noticeable worsening over the preceding six months, marked morning stiffness, pain aggravated by lumbar extension, and bilateral buttock pain. Lumbar radiographs showed less than 25% degenerative spondylolisthesis of L5 on S1 with associated lower lumbar degenerative change. Previous conservative treatment, including medication, medial branch blocks, facet joint blocks, and a prior intradiscal procedure that provided only temporary relief, had failed to provide sustained improvement. Concordant pain provocation during the prior intradiscal procedure, followed by pain relief after lidocaine administration, supported a disc-related pain component. Because surgery was not feasible due to socioeconomic circumstances, she underwent intradiscal injection of 3 mL of Adinizer-processed MFAT into the L5-S1 disc. At baseline, the visual analog scale (VAS) score was 7 and the Oswestry Disability Index (ODI) was 36/45 (80%). Pain remained severe during the first month after treatment, but symptoms gradually improved thereafter. At three months, the ODI improved to 9/45 (20%) and the VAS score decreased to 2; these improvements were maintained at the two-year follow-up, when the ODI remained 9/45 (20%) and the VAS score further decreased to 1. Serial plain radiographs did not show a definite progression of listhesis on visual comparison. This single case documents sustained symptomatic improvement after intradiscal Adinizer-processed MFAT injection; however, causality cannot be established, and the findings should be considered hypothesis-generating. Further studies with controlled designs and objective structural assessment are needed.