Back pain and Platelet Rich Plasma? RS is a 19 year old female figure skater who was first seen by our clinic for chronic low back pain in November of 2012. She reported a 3 year history of low back pain that was worse with skating, which she performed at a very high level (training between Canada and Colorado Springs). She also reported numbness in her leg in the L5 and S1 nerve distributions. Like some skaters she had developed a spondylolisthesis, a problem where a fracture or congenital weakness in a stabilizing section of the vertebra allows it to slip forward. The traditional treatment is surgical stabilization with fusion, which likely would have ended her career. She decided to pursue the Regenexx-DDD procedure rather than back surgery and had injection of her own platelet growth factors around the nerves as well as into her stretched ligaments. She had a procedure in November and December of 2012. She reports significant improvement in her leg numbness and back pain and is ramping up her training to continue to compete at elite levels.

NOTE:  Regenexx-DDD is a medical procedure and like all medical procedures has a success and failure rate.  Not all Regenexx-DDD patients experience the same results.

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This past week I’ve been hyper-focused on updating our long-term disc data and finally met my match yesterday. These are low back stem cell patients who had bulging low back discs treated with precise stem cell injections. It’s always an arduous task to pull all of this together, especially when some of the patients were treated in 2008 and 2009. Yesterday I called a woman from out of state. She was treated in 2009 by having her own specially cultured stem cells grown to larger numbers for a number of weeks and then re-injected into her low back disc using highly specialized imaging guidance. We could only inject one disc (L5-S1) and had plans at some point to inject her other L4-L5 disc. For our treatment registry and an IRB approved study, I needed a Likert number now and later an updated functional questionnaire. For those of you who don’t know, a Likert percentage of improvement is a great little number. This is what patients and doctors often use to communicate about the success (or lack thereof) of a procedure. For example, the patient might say that they feel 50% better. That little percentage improvement number encompasses so much: pain, function, and most importantly, value to the patient. It also transmits that information in a much more elegant way than say a standardized function questionnaire that might take 15 minutes to fill out.

So my question to this woman was: “On a scale from -90% worse to 100% better, how would you report your success or lack of success with the low back disc procedure?” She quickly replied that the horrible pain was 100% better, but that she still had pain from the L4-L5 disc that she needed to get treated. This was a problem for the scientist in me, as the 100% number she gave me didn’t really encompass the whole picture of her improvement, because she admitted she still had some pain. So I rephrased, ” Well if you had to look at the whole picture of your pain, what’s the number? I realize that the horrible pain is gone, but you’re telling me that you still have some pain from your disc we didn’t treat.” She replied that the pain that kept her from walking was a 100% gone, which was a very big deal for her. In addition, Dr. Schultz had hit that pain “dead on” when he injected her stem cells into that lowest disc. I thought to myself, Hmmmmm, this isn’t going to be easy. I rephrased my question a few more times, but I never could get another number and eventually our conversation drifted onto other topics. In the end I realized there was a conflict here. The scientist in me was only interested in a number that I could use to help quantify the success or lack of success of her procedure. Other numbers spit out of a functional questionnaire would follow. However, the physician in me realized that to her, she was being entirely accurate. The pain that disabled her for years died in full on that day in 2009 that Dr. Schultz injected stem cells into that part of her disc that was causing her the trouble. Almost like remembering a distant horrible memory, saying anything other than that it was completely eliminated from her consciousness 5 years ago was an insult to her experience. So what did I do? I reported it as, “100% relief of index disabling pain, patient still relays remaining pain from untreated disc that she is unable to accurately quantify”.

The upshot? My experience with this woman highlights the tug of war between scientists who love to quantify, doctors who understand that oftentimes quantification must mix with qualification in living and breathing patients, and the patients themselves who just want to get better and are generally oblivious at all of our attempts to define them by mere numbers. For patients it’s the experience that counts, and when you’ve had a painful and disabling monkey on your back for years and someone takes it away, it’s really “100% gone”. A valuable lesson that when the scientist gets thwarted by the difficult to quantify patient, that’s sometimes a good thing…

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Yesterday in the clinic I had two patients before lunch that define the differences between our traditional existing spine treatment paradigms and what our clinic defines as Regenerative Spine Care (using platelets and stem cells to treat patients with bad discs, facet joints, or ligaments). The first patient was a late thirties father who had been in a large clinic system with low back pain. This began when his small son tackled and surprised him about a year ago. He spent an agonizing 7 months in their “Pain Clinic” in acupuncture and chiropractic and in and out of physical therapy, which did no good. He then saw an interventional spine physician who decided he needed medial branch blocks. These are injections to numb the little nerves that take pain from the low back facet joints. These joints occur two at each spine level and are about the size of your finger joint. Since this numbing injection helped a bit for a few hours, he then underwent radiofrequency ablation (RFA) of those joints. RFA is when the doctor inserts a needle whose tip gets very hot and burns away the little nerves that take pain from the joint. This didn’t work well either. He still can’t sit on his left butt and his hip flexors on the left are super tight. So now that you’ve heard the traditional approach, let’s switch gears into a regenerative mindset.

When I evaluated this gentleman, I noticed that the multifidus muscles in his back were about 50% smaller on his MRI than they should be. This is a concern, as these are important stabilizers of the back. It’s also a major concern, as RFA also ablates the little nerve that supplies these muscles, so if we reimaged his back now, one month after his failed RFA, I bet those muscles are now mostly gone. Can you say, “Really unstable back?” His MRI had a good sized disc bulge at L1-L2 that the radiologist said was likely irritating the existing left upper lumbar spinal nerve. Since this nerve supplies the hip flexors, this is why they’re chronically tight. In addition, from his reading on the Internet, he figured out himself that his Sacroiliac Joint (SI Joint) was likely involved, he was correct. So our focus will be using the Regenexx-PL-Disc procedure on his L-L2 disc to try an improve the health of the irritated nerve which should reduce the hip flexor tightness. Once his medial branch nerve grows back in about a year, hopefully we can get his multifidus muscles back on-line (that’s an “if”). If we need to treat his facet joints, we’ll do that with platelet rich plasma or stem cells and not by killing off an important low back nerve. Finally, his SI joint became unstable due to damaged ligaments when his son hit him from behind, so we’ll focus on healing those stretched SI joint ligaments as well.

The second patient before lunch illustrates just how some patients can respond to a regenerative approach and the stark differences between that and a traditional surgical approach. This is a young gentleman in his mid-twenties who was in a horrible catastrophic car crash. He came in contemplating major surgery on his neck and back, as his spinal cord at C3-C4 was extremely tight in the spinal canal due to bulging discs, a small canal, and buckling ligaments. His L4-L5 area was the same. His pain diagram looked like the one above. Now why would a perfectly healthy 20 something have stenosis (a crowded opening in the neck and back bones for the spinal cord)? The leading explanation was that instability in the spine was caused when the major ligaments that stabilize C3-C4 were damaged in the car crash. This caused his smaller ligaments in the spinal canal to grow bigger to try to stabilize his spine. All of this combined with injured discs to reduce the room for the spinal cord, leading to intermittent compression of the cord and the whole body pain he was experiencing (since all signals from his body pass through this area). So I agreed to use the healing growth factors isolated from his own blood platelets to both try to heal these damaged ligaments and to improve the function of these pinched neck nerves. These growth factors were carefully placed under exacting x-ray guidance into the area around the nerves (epidural). After two treatments he returned yesterday to determine next steps. He had full neck range of motion (he had none before), no more neck or whole body pain, no more back or leg pain, and had begun hitting the gym again (whereas before he was disabled).

The differences between traditional spine care and the regenerative or Orthopedics 2.0 approach are stark. I got into the car with my office manager for a lunch meeting and told him we do some incredible things. Just a decade ago I would have been the one offering the first guy a radiofrequency procedure on his back or walking the second guy over to the surgeons office!

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What do low back disc stem cells results look like 4-6 years after treatment? In 2005 we began treating our first low back discs with stem cells. We expected to see what the animal models predicted, i.e. significant changes in MRIs-basically new discs regrown from stem cells. Regrettably that didn’t happen as we soon learned that the animal models researchers were using bore little resemblance to the real patients with degenerative disc disease we were seeing in the clinic. Over the next few years we did learn how to use cultured stem cells to help patients with disc bulges pressing on nerves and who couldn’t be managed with conservative treatments. This technology relies on cultured stem cells, so it’s not available in the U.S., but instead only through third party licensees who operate in countries where this type of culture isn’t regulated as a drug. We are working with a third party company to bring this technology through the regulatory hoops in the U.S.

A few weeks ago, I spent a huge amount of time going through all of our charts for treated stem cell disc patients. Some were treated with the second generation of what we believed was best to treat low back discs and some with a later third generation protocol. In addition, none received what we now consider our fourth generation protocol to improve the targeting of the cells in the areas that we believe will respond the most favorably. In addition, while we took great care to ensure that most of these patients only had low back disc pain, low back pain can be caused by discs, nerves, facet joints, SI joints, muscles, ligaments, etc… As a result, some patients had good results with their disc pain, but still had other pain that needed to be addressed. Note that I was able to update many of these follow-ups to the 4-5 plus year mark post-procedure.

The upshot? This infographic is a good example of the Regenexx difference. It contains the kind of details that you can dig up in smaller datasets (i.e. details about each patient) and still present in a manageable form. It shows a ground breaking technique in evolution, but still amazing in that many of these patients avoided big surgeries by a simple injection of their own stem cells. In addition, it’s not hype, but a careful, deliberate, and transparent reporting of the data as it was collected. As always, click on the thumbnail above for a bigger PDF.

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Regenexx Reviews…From Real Patients

In keeping with my goal of posting more individual patient reports, or, “Regenexx Reviews”  to balance out the hard core data I’ve been posting from the registry, here’s another Facebook post.  This one is about the excellent care delivered by Dr. Newton here at our Colorado clinic and the patient’s update on the  early outcome of her procedures.  This is our Facebook page if you want to add a like, in the meantime here’s what she said:

Debbie Ecksten

“Dr. Ben Newton and all the staff were beyond expectations. I travelled by air 2 1/2 hours to the clinic for L5 disc bulging and facet joint issues. My short term goal was to get some relief and not have to rely on any OTC or prescription …meds. My long term goal was to have my range of motion, considerable reduction in pain, and return to my fitness routine and riding my horse again. After two days at the clinic I boarded the plane home thinking at some point the numbing medication would wear off and I would slowly heal and have less discomfort. I’ve been home for 6 days since my procedure with absolutely NO PAIN whatsoever. Not even stiffness. I have worked out 4 times and my range of motion is back to what I had 3 years ago. I’m optimistic that my body has begun a fast track healing process without surgery or other conventional procedures suggested by my orthopedic doctor. I’m overjoyed and have told everyone about my experience. Thank you!!”

The upshot?  As a physician, our first goal is to do no harm.  Our second is to do all we can to accomplish the best possible outcome for our patients.  I’m thankful Debbie was able to use the healing power of her own platelets and stem cells in the skillful hands of Dr. Newton…and avoid the risks and recovery time involved in surgery.

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RP is an elderly physician who I met in the most unlikely of circumstances. He was performing a life insurance physical on me and I noticed he had a cane. We struck up a conversation about his severe buttock pain after a fall. The next thing you know I had him on my exam table and our roles reversed-the patient was examining the doctor. His story might be helpful to other patients with buttock pain after falling, as his case was one of a bright, shiny object which looked like the cause of his pain and a more subtle problem which turned out to be the cause.

RP is an ex-military doctor who now makes a living in retirement performing life insurance physicals. He looks nothing like an ex-military guy, instead he has an earring and wears wild Hawaiian shirts. Perhaps he’s making up for all of those years in fatigues. He fell a few months before I first met him and as a result he had severe pain in his right buttocks. After a stay in the ER where x-rays showed no fractures, his family doctor followed the religion of “take NSAID drugs and stay off it”. However, after several visits to his family doctor produced no results other than a refusal to perform an MRI, he was frustrated. In addition, during this time he went from an active elderly man to becoming dependent on a cane to hobble around.

When I first examined him during my own insurance exam, I immediately noticed a large lump in the gluteal muscles of his buttocks. A quick in office ultrasound revealed a hematoma the size of a small egg from the fall. This seemed to be tender so I attempted to remove the blood under ultrasound guidance. That usually doesn’t work because the blood has long since turned to sludge that won’t budge and it didn’t work here either. However, while this was the “low hanging fruit”, he also had evidence on exam of a rip roaring sciatica (pinched S1 nerve in his back). A low back MRI revealed a large herniated disc (his back hurt some, but most of his attention was on the butt pain). He underwent the Regenexx-PL disc procedure for his irritated low back nerve and I saw him today, without his cane! He now no longer limps and is grateful.

What’s interesting about RP is it illustrates what happens to a lot of patients with buttocks pain after a fall. They see their family doctors who prescribe anti-inflammatory drugs and maybe some PT, but when the pain doesn’t get better, there’s often a reluctance to really dig deeper. Some of these patients have injured muscles, tendons, nerves, or ligaments-but all too often they get blown off. To figure out the cause and treat the problem often takes just someone who is willing to look for the problem.

The upshot? RP’s “pain in the butt” was quite real. While he had a massive collection of blood from his fall that nobody found until an ultrasound revealed the issue, that turned out to be “window dressing”. The real cause of his severe butt pain and inability to walk was a pinched nerve in his low back. A quick injection of the growth factors from his own blood platelets quickly helped him recover!

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Low back pain due to a pinched nerve (sciatica) is a common problem that used to require surgery most of the time. A big medical advance of the 1980s was the use of epidural steroid injections to reduce pain and decrease the chance that a surgery would be needed. However, is there hope when low back pain continues despite a cortisone injection? DE is a 51 year old woman who can serve as good example of what happens when there is no sciatica epidural recovery.

DE was seen by Dr. Newton in our clinic in February of this year with a history of several years of low back pain due to falling off a horse in the spring of 2012. Her pain was located in the left low back and got worse with intense fitness activity such as jogging-but walking standing, or sitting for long periods would also exacerbate her symptoms.  She also had sciatic symptoms down her leg that started in November when she bent over and just twisted the wrong way.  She tried two epidural steroid injections in December (by another provider), which did knock down the leg pain, but she continued to have low back symptoms. When she was seen this year, her pain on a daily basis still ranged from a 1 to 2 all the way to a 7 to 8/10.

One of the things that Dr. Newton immediately recognized was that just pumping more steroids into a middle aged woman by repeating the epidural steroid injections wasn’t a good idea. In part, this was due to recent research showing that this causes significant bone loss for every steroid injection. In addition, rather than having tunnel vision and thinking the patient must only have a sciatica disc problem, he understood that the first place to look for issues in a patient who has fallen on her butt was the SI joint. These strong ligaments help to hold the SI joint and pelvis together and when lax and damaged, will often mimic a herniated disc and cause not only low back pain, but also leg symptoms.

Dr. Newton used the Regenexx-DDD procedure to place the patient’s own growth factors around the irritated spinal nerves and also injected the same growth factors into these damaged ligaments. The results? Here’s a report from the patient:

“Hi Dr. Newton:

Hope you and your family are doing well.  I wanted to give you a quick update.  Absolutely, no pain anywhere!!  I’ve been increasing my workout intensity.  Here is my latest accomplishment – 15 unassisted bar pull-ups, 20 hanging leg knee raises and 15 hanging straight leg raises.  I haven’t done any of these exercises in over 4 years or longer…

Can’t thank you enough for all you have done to greatly improve my back issues and obviously, quality of life!!

Take care,

DE”

The upshot? All too often, pain management doctors get tunnel vision and only focus on one problem, in essence going after the “bright shiny object” that shows up on the MRI but ignoring what makes sense from the history (i.e. in this case that the SI joint ligaments are frequently injured in a fall). We will continue to follow DE as she gets back to more of the high intensity exercise!

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Chris Warner is an inspirational speaker and expert mountain climber who can tell us a thing or two about climbing back pain and how he never lets it slow him down. Chris was recently seen by our Colorado clinic before a big Nepal trek. Suffice it to say that his e-mail about the results of his low back and hip treatment is one of the most gripping stories that I have heard in ten years of using PRP and stem cells to help patients.

Chris has been a patient of our Colorado clinic these past several years and was seen by Dr. Schultz in January of this year. Like many patients diagnosed and treated with a hip labrum tear, his 2011 surgery for impingement was less than 100% successful because his hip pain was also coming from his SI joint and irritated low back nerves. This spring, before climbing season began, he was seen by Dr. Schultz for the Regenexx-PL Disc procedure and treatment of his SI joint and hip. From this point on, it’s better to let him tell the story, as I would never do it justice (I redacted some of the more graphic parts):

“Nothing but great reports about the hip/SI joint, etc. I am amazed at how well the April shots worked out. I haven’t felt better in years, despite the crazy stresses I put on the joints while in Nepal.

I had one episode in which I thought I had re-destroyed all your good work. Rumor hit us that a French climber was being aided off the peak with Cerebral Edema. Two of us jumped into action, carrying supplies up the mountain to build him a stretcher. Minutes before he got to us he stopped assisting in his own rescue and slid into unconsciousness. We built a “stretcher” out of a tent, sleeping bag, pads and ropes, then started the terrible, cold, night time descent with the unconscious body. He was breathing at camp 2, but we had no sign of life by Camp 1. Still hours above base camp, we hauled, dragged…him… It was physically and  emotionally brutal. At one point, (carrying) him across a super steep slope, with a gaping crevasse at our feet, I could feel my back twisting as I pushed and pulled him. I had an awkward load on my back making things worse: oxygen tanks which we hoped would make him better, but now were useless. My heart was pounding from the immediate and accumulated physical strain. I thought for certain my body would fail, if not in the moment, in the coming days.

Late that night…I declared him dead. My biggest concern became the safety of the rescuers. At that point, we were going to have to carry him…across a dangerous talus field, down a roped cliff and more than a mile to base camp, all in the dark in sub freezing temps. Broken legs and torn ligaments were likely…We were physically destroyed…

On the walk down, I realized I still had the oxygen bottles in my pack. My lower back was killing me. I wondered if my trip was over.

I woke the next morning  to minor soreness. By lunch I felt dehydrated and exhausted but was pain free.

A few weeks later we made our summit push. I was cranking: until 7600 meters. During the rescue, the intense inhaling and exhaling of freezing air had scarred the back of my throat and caused an upper respiratory infection. This caught up with me as I crawled from the tent for the summit. I felt claustrophobic and soon realized that I was suffering from pulmonary edema. It was time to rescue myself, instead of becoming a statistic. No need to risk the lives of others. The descent, through the night, was long and brutal, but safe.

It all sounds epic, but really that is climbing in the Himalaya.

I am now home, taking a week to “recover”. I have a 70 mile mountain bike rae in late July, then the Leadville 100  mountain bike race in early August. Luckily my spine and hips feel great. I suspect that my lungs will be fine as well.

 Thanks for “squeezing me in” in April. I am doing my best to get the most from those shots.”

I was struck by Chris’ story for how in the most horrible of times, even when the rescue can’t save someone’s life, the resulting story is important to tell as for many of us, this is the only window we’ll get into this unforgiving world of elite mountain climbing. We’re glad we could help Chris and keep him going so that he himself could make it off that peak.

The post What Climbing Back Pain? A Story of Heroism and Courage in Nepal appeared first on Regenexx™.

What if you had a dream of something that you could do when the kids were grown and you were more financially secure, but by the time you get there, your body wouldn’t cooperate? In a nutshell, this is Kathie’s story; she dreamed of having the time to volunteer to plant coral and save the world’s coral reefs, but her back problems would no longer let her dive. What did she do? Did she turn to risky back surgery? No, she sought spinal stenosis surgery alternatives and turned to Regenexx.

When we first saw Kathie about a year ago she had severe upper and lower back pain. This meant that she could no longer use the kind of fins that were needed for scuba. Her upper back and rib pain were a simple matter of some damaged ligaments and this problem was easily fixed with the Regenexx-SCP procedure. However, her low back problems were a bigger deal because not only did she have had bulging discs, but also spinal stenosis and instability. This meant that her low back nerves were constantly being irritated by bone spurs and excessive movement from the vertebrae. In fact, the bone spurs that were pressing on her nerves (stenosis) were forming because of the loose ligaments in her back. So injecting stem cells into her discs would never be enough to solve her problem. In addition, spinal stenosis surgery would be risky, as her activity level meant that the needed back fusion would quickly overload the levels above and below the hardware, leading to new low back problems. She desperately needed a spinal stenosis surgery alternative.

Kathie found us underwent the Regenexx-DDD procedure three times. In this procedure, not only do we focus on the disc and nerve issues, but we also treat the lax ligaments leading to degenerative instability. What happened? Here’s an e-mail from her:

“Hi Jessica,

Just wanted to pass along my deepest “Thank You” to you, Dr. C and the entire staff. It has barely been a year since my first treatment. I am now back doing what I do best…dive, dive and more dive!

Yesterday I planted 10 new Elkhorn Corals on Molasses Reef, with the Coral Restoration Foundation. A volunteer opportunity that was beyond my physical abilities a year ago. I have no words that express my true gratitude, all I can say is “Thank You” for giving me my life back.

These ten corals I dedicate to you Dr. Centeno.

Kathie”

So somewhere, on the bottom of the ocean, new coral is growing, dedicated to Regenexx! We’re very happy we could help Kathie get back to that dream!

The post Spinal Stenosis Surgery Alternatives-Helping a Diver Return to Saving Our Coral Reefs appeared first on Regenexx™.

We arguably have more experience with injecting stem cells into the discs of patients than anyone else on earth, having performed our first case in 2005. While placing stem cells in discs can be helpful in certain circumstances, can we provide back fusion alternatives without poking a hole in the disc? This is an example of a patient treated with the Regenexx-DDD procedure who now has MRI evidence that her disc is improving without ever having the disc itself injected. How’s that possible?

First, one of the most common spine surgeries today is low back fusion. Patient’s are often seeking alternatives to back fusion because the side effect profile for the surgery is horrendous. The main thrust behind a back fusion is to “stabilize” a bad disc.

Physicians and patients often have a “disc fetish”. The intervertebral disc (“disc”) is a shock absorbing spacer that lives between our spine bones. It can degenerate, meaning it can be damaged and bulge or collapse, pressing on nerves. What most patients and many physicians don’t know about degenerative disc disease (DDD) is that one of it’s biggest elements is instability, where the disc itself plays only a bit part. White and Panjabi talked about this in their 1978 book, Clinical Biomechanics of the Spine, so we’ve known about this for a long time. In fact, instability does as much or more damage than a bad disc. It can fry facet joints, cause bone spurs that can press on nerves, and irritate nerves itself.

It’s because of this DDD related instability that patients are not always fixed by injecting magic stem cells into the disc. In fact, this is why we created the Regenexx-DDD procedure. The goal of this procedure is to avoid surgery by injecting an advanced third generation mix of platelet growth factors into or around all of the non-disc elements of what Panjabi called the FSU (Functional Spinal Unit).  So the ligaments, joints, and nerves at the degenerated level are treated-the ligaments being lax because of the DDD, the joints being painful because of the extra wear and tear of the instability, and the nerves being aggravated for the same reason. In addition, rather than blind injections, we’ve developed advanced fluoroscopy techniques that allow the physician to target previously uninjectable, but important elements of the FSU. Many times the patient will respond beautifully without treating the disc, but sometimes the disc needs to be treated as well.

This morning’s patient is a middle aged woman who had a several year history of disabling low back pain that wasn’t improving. The traditional pain management approach of injecting anesthetics and high dose steroids into each individual structure (i.e. around her nerves or into the facet joints or into her SI joint) was providing small amounts of about 20% short-term relief with each injection. One of the things the Panjabi FSU teaches us is that in DDD, it’s much more likely that multiple structures will need attention. Hence rather than only injecting a single structure, we used the Regenexx-DDD procedure to inject her advanced platelet growth factors into her ligaments, joints, epidural, and into her SI joint. She’s had nice robust pain relief after her procedure and was able to reduce her medications for the first time since her pain began progressing. Her Internist decided to take another MRI to see if these positive symptoms changes had anything to do with changes in the structure of her spine.

The image below shows the L4-L5 disc bulge and “HIZ” (High Intensity Zone of disc tear which is the white part of the disc bulge) in the before image. In the after procedure image, the bulge is better and the HIZ is much less prominent. This was accomplished without injecting into the disc, rather improving the degenerative instability by helping the ligaments and injecting beneficial platelet growth factors at the back of the disc.

The image below is the L2-L3 disc seen from the top. Note again that the bulge is smaller and the HIZ looks better, again without injecting into the disc.

Finally, another part of DDD instability is that the facet joints and spine bones react by making more bone. They do this to try and stabilize the spine. So if you can stabilize the spine by beefing up the ligaments through injection, the bone spurs on the joints for example (that can press on nerves) should resolve. Below is an image of the right L3-L4 facet joint before the Regenexx-DDD procedure showing a right medial facet joint cyst, swelling, and bone spur. This changes the shape of the spinal canal (white triangle shaped structure with the dots (nerves)). This reduced incursion into the spinal canal allows more room for the descending nerves.

The upshot? While injecting stem cells into low back discs can be very helpful in certain circumstances, injecting anything into a disc carries more risk than not performing that procedure. Hence when you can reduce disc problems by just injecting 3rd generation, healing platelet growth factors into the ligaments, joints, and around the disc/nerve, that’s less invasive. In our book, less invasive always trumps more invasive!

The post Back Fusion Alternatives? Can You Avoid Surgery without a Disc Injection? appeared first on Regenexx™.

This has been a great clinic week in Grand Cayman. I’m so thankful that we have such wonderful patients who trust us to help them. I’ve also loved some of the patient stories this week. Here are some of my favorites.

I blogged earlier on JG, a businessman whose ankle we treated awhile back with the Regenexx-C procedure. What I didn’t know was that he was told by his fancy Manhattan orthopedic surgeon that this stem cell stuff would never work and to return when it failed. When it worked, he booked a cash visit to see the surgeon, just so he could rub it in a little. When the surgeon asked him if he was now ready for his surgery, he got up on his tippy toes and told him he was only there to show him how wrong he’d been!

There’s also BB, a patient who has retired young and is traveling the world now. He was treated with the Regenexx-C procedure 6 years ago for a hole in the knee cartilage. He also saw his Manhattan orthopedist at that time. He wanted to perform bilateral high tibial osteotomies, an extremely invasive surgery where a wedge of bone is cut out of the tibia to take pressure off of the inside compartment (where the hole had formed). BB reminisced yesterday as he got his tune-up stem cell injection how his life in retirement would have been vastly different if he would have consented to that big, invasive surgery. Instead, a single injection series gave him 6 years of relief!

Finally, there’s AG, a young man with a degenerating L5-S1 low back disc. He’s been helped by the Regenexx-PL-Disc procedure in that his disc bulge size is dramatically reduced and his multifidus atrophy is significantly better. However. because he’s loosing disc height, he would like to get cultured stem cells placed in the disc as he continues to have back pain that’s likely discogenic.

The upshot? This thanksgiving I’m thankful for our great Regenexx patients. They do their research and check everything else out and come to conclusion that Regenexx has the most substance behind it of anything being offered in orthopedic stem cells. They are a pleasure to treat and it’s a real honor that they place their trust in us.

Regenexx-C is not approved by the US FDA and is only offered by independently owned and operated facilities outside of the U.S. where culture expansion of autologous cells is allowed under local regulations.

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Many of our patients have a similar story. They’re active people, often pursuing a dream that requires them to be active, and then one or more injuries catch up with them and their dream is placed on hold. They do their research and soon learn that traditional orthopedic surgical procedures aren’t the answer, so they go looking for surgical alternatives and find us. Josh is a good example of an active guy with a dream who was being held back by injury, but who was able to push through with the help of various Regenexx procedures.

Josh is a 34-year-old firefighter who had knee pain and neck pain. He first injured his knee, approximately three years ago, but that resolved fairly quickly. However, when getting into jiu-jitsu in February of 2014, he began having increasing knee pain with catching and popping. The pain was severe enough to prevent him from performing jiu-jitsu, so he tried physical therapy, but the issue remained. Josh began having neck pain again in March after a year and a half of lower level pain at the back of his shoulder blade. When jiu-jitsu really flared it up, he had numbness and tingling radiating into his thumb and second finger. P.T., massage, and chiropractic only helped temporarily. His neck MRI showed a disc bulge pressing on the C6 nerve and his knee MRI showed meniscus tears, some early arthritis, and a bone marrow lesion.

So what did we do? Surgery to remove the disc and parts of the meniscus? Nope, both would be a dumb idea setting him up for more arthritis and problems down the road. In his case, we injected his lax MCL, ACL, and torn meniscus with ultra-precise injections of his own super concentrated platelet rich plasma (SCP Procedure) and treated his neck with the PL-Disc procedure as a neck surgery alternative.  His result? This is the e-mail and picture he sent (pic above):

“I just wanted to take a minute to thank you and everyone else at Centeno Shultz for doing what you do. With my cervical disc herniation and my torn meniscus I didn’t think I would be able to continue working as a firefighter or continue to train Brazilian Jiu Jitsu and Muay Thai boxing. Since the first procedure I have improved greatly and have been able to train and perform both at work and in the gym. This week I was awarded my blue belt, I never thought I would reach that goal. Thank you!”

The upshot? We’re grateful that we could help Josh get his blue belt and continue to save lives as a firefighter! We’re also proud to say that this is what we love to do-help aging athletes with injuries keep moving without invasive and life changing surgery!

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The issue of stem cells and disc problems is a complex one that often gets simplified by doctors advertising stem cell spine treatments into: “stem cells are magic fairy dust to be sprinkled on the spine to cure even severe degenerative disc disease”. The truth however, is much more complex than this simple message. Based on our decade long experience of treating the spine with stem cells, in order to understand where stem cells can help you have to first understand what kind of problem you have. This “Back and Neck Stem Cell Treatments video” is my attempt at trying to fit the pathology of the back and neck to the best autologous biologic technology-whether that be platelet rich plasma, platelet lysate, or stem cells. I had a bit of a cold when I recorded this, so excuse my voice, as at times I sound like a teenager. Enjoy!

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PA is a local attorney who had the misfortune of having low back surgery in high school, which led to back surgery problems in his 40s. Being an active aging athlete with a dirt bike career on the side, one day in 2013 his back gave out. He was told he needed surgery, now almost two years later he’s never needed that procedure thanks to Regenexx and Dr. Schultz’s excellent care.

One of the big downsides of low back surgery at a young age is that the disc often collapses after the procedure. In PA’s case, by 2013 he had severe degenerative disc disease with stenosis due to arthritis putting pressure on the S1 nerve. His L5-S1 disc was completely collapsed.

When he first saw Dr. Schultz, PA had numbness and tingling down his leg (sciatica) and had failed physical therapy. The next step in his treatment was an epidural steroid injection (ESI) or low back surgery. A steroid ESI injects a powerful anti-inflammatory, but also inhibits local healing. From a surgical perspective, options included an artificial disc or a fusion. The former would insert a hockey puck sized piece of metal into his back that would have to be replaced a few more times in his life. The latter would mean that the L5-S1 level was fused solid, causing overload and arthritis of the SI joints below and the L4-L5 segment above.

Instead of all of that, PA chose Regenexx procedures. He had one Regenexx-DDD procedure focusing on using his own growth factors from his blood platelets to calm down the nerves in his back and provide additional stability by tightening ligaments. That was followed up by three more procedures in 2014, which allowed him to finish to the 2014 dirt biking season. This is what he wrote to Dr. Schultz:

“I feel like I should tour high schools or have a second opinion brochure in the waiting room or a hotline for people in my situation so I can stay STOP –Don’t do it!  You can heal and even race endurance dirt bike races if you go see John Schultz!!”

PA is of course referring to his bad decision in high school to have low back surgery.

The upshot? As PA says-don’t get back surgery! While this seems like a simple and obvious message, you’d be surprised how many patients, in agony for just too long and not fully briefed on advanced non-surgical options like Regenexx, end up under the surgeon’s knife only to regret that decision!

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Stem cells for back pain have been a big topic this past year or so. This is the story of Claire, who I think like many, believed that a stem cell injection in her spine could help her disability. When I first saw her MRI and heard her story though I was a bit daunted, I knew that she would need a broad array of regenerative technologies deployed in specific areas to give her the best chance of success and that likely didn’t include stem cells out of the gate. So we focused our efforts on using various advanced preparations of her own blood platelets and platelet growth factors injected precisely around specific nerves and into specific joints and ligaments. Here’s her story in her words after her first round of injections:

“I was badly injured in a car accident over two decades ago. Although I suffered occasional periods of prolonged incapacitation, I was always able to resume living an active life without surgeries or narcotic drug dependencies. 

Fast forward to my mid-forties: I was back in peak shape, working out strenuously again. I was doing eight to ten miles on an incline trainer four to six days a week; I did Bar Method or Total Gym work-outs on the other days. One day, it felt as if a wall of pain just hit me; it began with severe pain radiating down both legs, making it impossible for me to remain in a seated position for more than five minutes. I couldn’t lie on my back for more than twenty minutes without my lower back going into involuntary spasms; thus, sleep was elusive even with high dosages of sleeping medication. Trying to hold still for an MRI while on my back was almost impossible; I had to take heavy doses of pain pills and muscle relaxers to lie still long enough to complete the imaging without shaking uncontrollably.

My knees began to buckle, which resulted in countless falls, one of which broke my right (dominant) wrist. Eventually, I had absolutely no comfortable position left. I couldn’t sit, stand, walk, or lie on my back or sides; I had to constantly change from one excruciatingly painful position to another. Walking became increasingly difficult and I had to use a wheelchair, which was emotionally devastating. I became a disabled “shut in” who was dependent upon others for almost everything for over two years. I felt my life was over; I seriously contemplated suicide on a number of occasions.

Updated MRIs revealed that rapid deterioration of my spine and knee injuries had occurred with age. My diagnoses include multiple herniated, bulging, and degenerated discs at almost every level of my spine and pinched nerves between these discs. The lumbar spine is the most severely degenerated: L-3, L-4, and L-5 are virtually rubbing “bone on bone.” I am also diagnosed with spinal stenosis, scoliosis, DDD, and secondary osteoarthritis of the spine. Both knees are diagnosed as subluxated, with torn menisci, secondary osteoarthritis, and a cyst in the left knee. I am also diagnosed with tendinosis of the right tendon and told I have a “repetitive stress injury” in my left elbow.

My neurosurgeon recommends fusion of a number of the discs and the installation of a narcotic pain pump in my back. My knee specialist recommends arthroscopy of both knees along with some additional procedures. I am prescribed a cocktail of pain pills and muscle relaxers that I seldom take. Taking only one of these substances makes me a zombie and I have horrible side effects from the meds.

Having extensively researched the use of bone marrow derived, autolgous stem cells to treat orthopedic injuries, I decline all traditional, invasive orthopedic surgeries and tell my doctors of my plans to seek treatment from Dr. Centeno; my GP, the neurosurgeon and the orthopedic surgeon scoffed at my treatment plans. Fortunately, I have three other physicians, including one educated at Oxford, who fully supported my choice of treatment and choice of physician, in lieu of traditional, invasive orthopedic surgeries.

Dr. Centeno treated my lumbar spine twice; he also treated both of my knees, my cervical spine, right tendon, and left elbow. After years of forced inactivity, I’m now able to resume my home-based physical therapy, followed by walking two miles at two mph on a treadmill on an almost daily basis. The left elbow pain seems to be gone, as does the tendinosis. The pain in my legs and knees is less severe now. If I had followed the orders to have the traditional procedures and taken all those narcotics, I would likely still be confined to a wheelchair, facing a life of endless surgeries and narcotic drug dependencies.

I still have a long way to go in my recovery, but this is infinitely preferable to being stuck in a wheelchair for life, having repeated surgeries, and being dependent upon a cocktail of nasty narcotics!”

So while she may need at some point to have stem cells injected into her disc, I’m encouraged that a broader treatment approach is helping get her back to being active again!

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We received this Colorado Regenexx Patient Review recently from a patient who wanted to share his experience at Regenexx Colorado. When he contacted Regenexx he was in excruciating pain, and his local physician’s treatment had made the situation worse rather than better…

“So, recently I started to get a pain in my right arm, just below the shoulder. It started small then escalated to a major pain.  It felt like a vice grip was on my upper arm squeezing tighter and tighter and radiating down my forearm.  It got so bad I was loosing sleep.  The only time I got a small amount of relief was sitting down with my chin touching my chest.  I went to my doctor and they shot my shoulder with steroids and gave me a prescription for a week of steroids.  A week later the pain was worse.  They told me to go to the emergency room.

I had been following Regenexx, and decided to contact them. My phone consultation was with Dr. Centeno. He said  “sounds like a pinched nerve at C5 or C6″  and because of that recommended I get an MRI of my cervical spine as well as my shoulder.

I got to the MRI place, and I just could not go through with it.  They wanted me to lay flat on my back.  The pain was worse when my head was fully back lying down and they said they could not raise my head.  So, the MRI was a no-go.   Dr. Centeno recommended I try the “Stand Up” MRI.  Well, that went great.  I was able to be positioned so my head did not need to be fully back.

The MRI was conclusive, and confirmed I had a disc bulging out and pinching the nerve bundle at C6 and some arthritis in the small openings where the nerves go through the bone down to the arm.  Dr. Centeno also noticed that I had an  issue with a torn Rotator cuff.  The pain from the cuff I knew about, however, it didn’t bother me and only hurt when I was doing something like throwing a ball…  The pain from the pinched nerve though was unbearable and totally unrelated to the cuff issue.

Dr. Centeno recommended Regenexx SCP (and if needed other Regenexx platelet products) .  He also recommended I start taking the Regenexx Advanced Stem Cell Support Formula and the Regenexx Turmeric Curcumin Complex.  I have to say that 2 or three days after taking them, the pain started to go away.  It was still there, but it was now bearable.

So,  I made the reservations and flew out to their Colorado clinic when they could see me.  It’s in a little town just south of  Boulder called Broomfield.   My appointment  was for a Cold Friday morning to have blood drawn.  At 9:30, right on time,  I was escorted to a room where a nice young lady took my blood an did an excellent job as I have deep veins.  When done, I was told to return at 1:30.  So, we went for some site seeing.

 I returned at 1 PM.  At 1:30 right on time, I went into a room filled with cool electronic video stuff.  Dr. Centeno came in, did an extensive exam, explained the procedure and got to work.  I felt very little pain when he numbed the area and then injected the SCP into my spine and shoulder.  The whole thing was over in about 30 minutes.

I know, Long story, so let me tell you the result.  I felt almost immediate relief.  By the time we got home the next day the pain in my arm was almost gone. ( By the way, Dr. Centeno wrote a script for pain medication… I did not need it..)

A week later the only pain I had was at the insertion points.  This was minimal and almost unnoticeable.  The vice grip pain in my arm is completely gone.  My cuff injury is 80% better.  I can now throw a ball again, and while the cuff injury still lets me know it’s there, it’s nothing to complain about.

I don’t know if I will need additional treatments.  I am going to have another MRI in the future to see how the disc looks, but for now I couldn’t be happier and I am completely  pain free.” ~ JH

We’re thrilled JH is doing so well!  His story is very typical of the patients we see, and highlights the importance of seeing a physician who can make an accurate diagnosis.  JH did everything right on his end and his shoulder will likely continue to improve.  Believe it or not it snowed when he was here in the middle of April, so while we hope his next trip to Colorado will be to get a better look at our incredible mountains, if a touch up is needed at some point, we’ll be here!

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Like every procedure ever used in the history of medicine, ours has it’s successes and failures. For a physician, the successes are always more fun and some of those can get to be routine. However, every once in awhile you see a patient were the success was life changing. SR and her low back disc stem cell procedure  is one of those wonderful successes.

I first blogged on her a few years back when I first saw her for SI joint problems. She was a real head scratcher, a young girl out of school due to back pain who was sidelined from competitive cheer-leading who had seen other physicians and tried lots of conservative care. Eventually I found a cyst on the front of her SI joint that was irritating the nerves going to her leg. We were able to treat the joint and get rid of the cyst and she promptly went back to school. This past year she returned to see me with severe back pain, again out of school and out of cheer-leading. I of course tried what had worked in the past, only to have it and everything else we tried like platelet epidurals, facet injections, and ligament injections fail. As a last resort, I noted that she had a disc bulge at L5-S1 on her more recent MRI that I felt could be causing the problem, but sending a young girl like this to surgery at 17 was sure to have her end up with a lifetime of back pain beginning in her 30s. This is when I suggested that her parents try the cultured disc stem cell technology we pioneered that’s now available in Grand Cayman.

Above on the right is her pre-injection MRI showing a good sized disc bulge at L5-S1. On the left is her 5 month post stem cell injection image. The disc bulge that used to measure almost 5 mm is now about half it’s former size and her pain is down from an 8/10 to a 0/10. She’s back seeing a personal trainer to get back in shape and will start back in school in the fall.

The upshot? SR is one of those patients that I’m really happy we could help. She’s dodged the bullet twice now with regenerative medicine. We wish her a great school year!

The Regenexx-C procedure is not approved by the US FDA and is only offered in countries via license where culture expanded autologous cells are permitted via local regulations. 

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RT is a 56 year old male with a very long history of back pain which began in the 70’s when he injured himself on a boat. He’s one of the more recalcitrant back pain patients that I have seen in years, failing to show significant improvements with just about everything we, or anyone else, did. That was until he got a disc stem cell injection, which seemed to be the only thing that’s been able to put a significant dent in his back pain.

At a young age this patient injured his back and found himself in the infirmary for a month. His pain eventually recovered to the point where every once in awhile he would have severe back pain episodes, but they would subside quickly. About 2008 these episodes began to take longer to go away, so he got a surgical opinion. He was told that he had disc annular tears and that there was no surgical treatment. Another surgeon told him that a low back fusion was the next step. Then in 2014 after long car trip he began to get L5 symptoms down his leg, so he signed up for an epidural, which helped a little. Activity after that would cause a his back to get side bent (a list). When I first saw him for an evaluation last summer, he was having 7/10 pain and despite being an avid cyclist, could only ride his bike 11-20 minutes. He had already tried SI joint injections and facet injections, but neither did him much good.

We first tried injecting platelet rich plasma and platelet growth factors around his irritated nerves and ligaments, but after several rounds of treatments that usually have a high success rate, we weren’t really getting anywhere. Given his sitting intolerance, his impressive MRI disc tear, and the fact that traditional injections that usually work weren’t helping, I agreed to try a disc stem cell procedure with Regenexx-SD. I injected his L5-S1 disc in December of 2014. As is common with disc injections, he was significantly flared up for 6-8 weeks or so, but then began to turn the corner. By April he was reporting 4/10 pain and much more importantly, much fewer days of severe pain. By July her reported:

“I’m feeling consistently around 60% of normal.  I’m riding about 60 miles a week and swimming twice for about 40 minutes each.  My back is always kind of tweaky and I can’t walk too much without pain, but am feeling so much better than I did a year ago.”

His before and after MRI is above. The MRIs were regrettably performed on different scanners, so we’re having the post injection image repeated on the same machine. However, the closest slice match between the two shows that the large tear in the back of the disc (white line in the dark disc blow up on the left) has gotten smaller (less white in the dark disc in the blow up on the right). These look like positive signs. The big question is whether we want to re-inject the disc a second time. In the meantime, we’ll go back to platelet growth factor epidurals to continue to reduce his pain, as there’s a good chance these will work now that the disc looks better (i.e. is no longer leaking bad chemicals onto the nerve or leaking less).

The upshot? It’s so good to see Rodger heading in the right direction. This was one of those times where the only thing that could help him was a disc stem cell injection, which is usually not the case for many patients we see. We may re-inject the disc, but in the meantime, at least he’s back to more of himself!

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Torn discs can be painful, but are often missed as a cause of pain, usually lumped with garden variety degenerative disc disease. Some of the patients with these tears that have chronic pain end up with surgical fusions. However, are there torn disc surgery alternatives? DA is a good example of how many different injection based treatments are often tried for this problem.

First, the discs in your low back act as shock absorbers between the back bones. They have a tough outer covering called the annulus and a softer gel like center called the nucleus. The annulus can get torn with wear and tear or trauma and nerves can grow into the tear, which can cause pain. Many times these painful tears will appear as a white spot in the otherwise dark disc on an MRI. These are called high intensity zones (HIZs).

DA is a 40 year old patient of Dr. Pitts with more severe spine problems that began with constant low back pain in October 2013. Before that, he had a seven to eight-year history of some mild low back pain radiating to the right buttock that was manageable.  In October 2013, the pain worsened and became more constant. It moved to the middle of the low back , radiating to the sides and into the right buttock down the outside both legs and to the top of the foot where he had some numbness, tingling, and slight weakness.  The pain was worse with bending forward to pick up things and aggravated by standing longer than thirty minutes.  He had tried one-time facet steroid injections, which may have provided some help.  He has also had epidural steroid injections, which didn’t help.  He also had radiofrequency ablation in February of 2014 that did help for four to six weeks. He has had a discogram at the L4-L5 and L5-S1 levels with subsequent injection of the amniotic growth factors in May 2014.  He feels that this helped somewhat as well.  He had also tried chiropractic, acupuncture, and trigger point dry needling.

The patient traveled down to Grand Cayman to get specially culture expanded mesenchymal stem cells injected into his disc. Above are his pre stem cell injection MRI and his 6 month post films. Notice the white spots (HIZs or disc tears) in the back of the two bottom discs (L4-L5 and L5-S1 in the grey dashed circles). These either go away or are much less prominent in the 6 month post treatment images. He reports about 40-50% improvement and Dr. Pitts is considering treating those discs a second time.

The upshot? DA is a good example of what people can experience with disc tears. They often try and fail a number of treatments including facet injections and radiofrequency, epidurals, and physical therapy/chiropractic. Until recently, outside of a lumbar fusion, there wasn’t much to offer these patients. For the last decade at our clinic since we’ve used stem cell injections in the disc, we’ve had a few options to treat patients like DA!

The Regenexx-C procedure is not approved by the US FDA and is only offered in countries via license where culture expanded autologous cells are permitted via local regulations. 

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Is disc replacement in a teenager a good idea? Is fusion smart or dumb in this age group? This was the dilemma facing Analisa, a 20 year old young woman with a bad low back disc. In the end, she used advanced regenerative spine care to avoid both surgeries.

Analisa had a painful disc at L3-L4 that was degenerating, despite being in her late teens. The discs act as shock absorbers between the bones of the spine (vertebrae). They can become degenerative and can sometimes be painful in patients who have had trauma or just with the wear and tear of life. What’s less common is that one would become a problem in a teenager, but hers started to be an issue at the age of 12.

When I first evaluated her in February of this year, she was miserable. Her L3-L4 disc was no longer holding onto water on her MRI (dark disc) and a discogram had shown it to be causing pain. She was at a very low level of function and was spending every day in bed and couldn’t walk long enough distances to go shopping. One local surgeon had told her she needed a fusion of that disc, which is a surgery where the disc is removed and hardware and bone solidifies that level so it no longer moves. Another surgeon had told her she needed a disc replacement, a surgery where this disc is also removed and then an artificial metal/plastic disc is inserted. Thankfully for her, her insurance company had more sense than the surgeons, as they denied both procedures. Why was each of these surgeries a bad idea?

As I tell all of my patients, fusion is a dog with really big fleas. What I mean is that when you fuse a spinal segment that was built to move as part of a coordinated machine that moves (the spine), you get a broken machine. The part that’s fused invariably overloads the parts above and below, causing new problems. A disc replacement is a surgery designed to try and fix the problems of fusion, by installing a hockey puck sized device that allows some motion. The problem is that not only is this a big surgery, but in teenagers, the device will have to be replaced many times throughout their lives due to wear and tear. Each surgery will be a bigger and uglier affair and have ascending risks for the patient.

So what did we do? We ditched the idea of both surgeries and used her stellar 20 year old growth factors found inside her own platelets to treat the irritated nerves around the disc and tighten the loose and degenerative ligaments at that level. This was a series of precise image guided injections without surgery. The results? She now only spends 1-3 days a month resting in bed, her legs no longer throb, and she can walk distances, so shopping is a go!

The upshot? Fusing the low back of a teenager is a dumb idea. I’ve seen it happen a few times in my practice (not under my watch) when young patients, in more pain than ever, came into my practice having had their back fused by an overzealous surgeon. Replacing a disc in someone so young isn’t much smarter. In this case, the patient’s insurance company pushed her toward a better option. While I’m no fan of insurers, we are seeing them take a harder stance on fusion and given that I would estimate that only 10-20% of patients who get this nasty surgery actually have no other good choice, that’s not a bad thing!

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