At our annual Regenexx network provider conference in Denver this past week, a network physician who is more focused on interventional spine came up and thanked me for introducing him to a new treatment for neck pain – platelet lysate. This one change had revolutionized his practice as he found it much more effective than injecting steroids into the epidural space. This reminded me of a review left on Facebook a few weeks ago by a patient who agreed that platelet lysate had also changed her life.

We’ve always done many things in regenerative orthopedics that that nobody else does. One of those things is isolating the growth factors present in platelet rich plasma and using those as a potent natural anti-inflammatory to replace the harmful effects of epidural steroid injections (ESI). The latter shot is used to help reduce swelling around irritated nerve roots, but can also have serious side effects like the destruction of bone and osteoporosis in middle aged and older women. By using this growth factor cocktail instead of steroids, not only can we get rid of inflammation around nerves and the side effects, but we also believe that we can improve the blood supply around compressed nerves.

Heidi’s journey as described in her post below is consistent with our experience of just how well platelets can work for patients. In her case it took awhile to latch onto the right injection route, but we got here there in the end!

“I had a sporting accident in 2006 and resulting C6 C7 fusion at the Mayo Clinic in 2008. Surgery and healing were as expected with no major complications except for the nature of my specific body. The post-surgical period was extremely painful and it took me a year to heal with the help of a bone growth stimulator. I lost two jobs because I could not maintain the required pace. Unfortunately, my adjacent cervical discs did not like the change. After exploring all options, including additional surgery, I began treatment with Dr. Centeno/Dr. Schultz in late 2012. At that time, I could not be upright after 3 PM. My life was severely limited. I could not exercise or work. My social life was over. The initial facet platelet lysate injection and two prolotherapy treatments did not help. (Spines can be notoriously difficult to pinpoint the cause of the pain). Mark Riley’s PT was wonderful. They had me wean off all narcotics, NSAIDS, a statin and baby aspirin (my PCP did not agree with eliminating the statin and the baby aspirin. It is challenging to reconcile differing advice from doctors involved in your care. At some point, you just have to pick the condition that is most important to your quality of life and go with that Doc) After about nine months of trial and error, a C5 C6 epidural platelet lysate injection in September 2013 gave me my life back. I now experience very little pain and only when extremely fatigued. My last injection was with Dr. Schultz a year ago. I had two injections in 2013 and two in 2014. I have not had an injection yet this year. I am starting to have a bit more pain and may have one before the end of 2015. Time will tell. For me, $500 per injection is a small price to pay for a life largely free of chronic, severe pain…These doctors are the real deal. They are on the cutting edge of medical innovation and treatment advances. The pain management doctor who treated me for five years with traditional narcotics and steroid injections was having them treat his knee. All of my second opinions from various practitioners, except surgeons, said this is clearly the future of orthopedics. I am a person who does her homework. Do not let anyone cut into your body without first exploring the possibility of a regenerative treatment for your condition. There may always be a place for surgery and artificial joints in some circumstances, but I urge you to explore healing your own tissue, with their help, if it is all possible.
Be careful in picking a regenerative orthopedist as many insufficiently trained practitioners have jumped on the bandwagon to make a quick buck. This practice has trained other physicians around the country. Also, know as much about your condition and the cause of your pain as you possibly can before you see your orthopedist because they are extremely busy. Don’t expect much bedside manner. I suspect, in my case, we might have tried an epidural instead of a facet injection first if I had a long talk with my primary pain management doctor prior to treatment at the Centeno Schultz clinic. After five years, I suspect he knew it was nerve pain rather than facet pain. But I never specifically asked anyone who had been treating me for years. That was a mistake. You have to be your own advocate. That would’ve cut almost a year of trial and error and pain and cost out of my treatment. And, especially if you are a woman, don’t accept any verdict that it is “all in your head”. Pain is a complex phenomenon involving your entire nervous system, including your brain, and the place of your initial injury, disease or other source of pain. Learn about pain. You will find recent research fascinating.
At the very least, do yourself a favor and read their downloadable book.”

We’re happy that Heidi is doing well and so thankful that yet another patient realizes what we doctors have, that platelet lysate for spine conditions is a game changer!

The post New Treatment for Neck Pain: Platelet Lysate and Heidi’s Journey appeared first on Regenexx®.

At Regenexx, our focus is always treating the whole athlete. One of the unfortunate things that happens in our modern world of orthopedic hyper-specialists is that injured athletes are broken down into their parts that hurt. The knee guy sees someone with knee pain, the foot and ankle specialist sees someone with foot pain, and the spine surgeon evaluates someone with back pain. Sometimes it’s a bit like that old adage of the blindfolded men examining various parts of the elephant. Such was the case with Sarah, a 12 year old with gymnast foot problems who had specialists focus on her toe and heel pain as if that was happening in isolation; it wasn’t. Thankfully, Dr. Schultz recognized that there were other causes that could be treated that explained why her feet were such a chronic recurring issue.

It’s amazing how many times we’ve seen patients with hip, knee, ankle, and foot pain who have had surgeries on these parts when the real cause was an irritated nerve in their low back. I would venture to guess that hundreds of millions are wasted each year on unnecessary surgeries on the wrong body part based on pain in that area and without anyone ever asking the question of whether that pain might be caused by the spine. How can a pinched nerve in the back convince both doctor and patient that the problem is really in the foot? Having had a neck issue causing severe shoulder pain, I can tell you that I would have bet a large sum that I had a shoulder problem. Why? The nerves that go from the neck to the shoulder or the back to the foot, when compressed, don’t generally cause neck or back pain, they cause pain in the area that they serve in the extremities. You’re body is completely and utterly unable to tell the difference. So if I could reach into your spine and pinch one of these nerves in the right way, you would be convinced that some part of your shoulder, arm, hand, hip, thigh, knee, leg, ankle, or foot was seriously injured!

Dr. Schultz first evaluated Sarah last month, who was a gymnast who had two injuries in 2014 – a stress fracture of the left heel and an injury to the big toe joint. Both were immobilized with casts. When Dr. Schultz saw her, she had a 3 month history of pain in the other toe joint which her doctors also tried to immobilize, but that didn’t work as well. She also had a 6 month history of low back pain.

Dr. Schultz’s exam was more extensive than the cursory variety she had received in the surgeon’s office. He quickly realized that the L5 nerve in her back was a contributing factor to her toe pain as when this nerve is irritated it’s felt by the patient in the big toe. In addition, she also had laxity in the ligament that holds the toe joint stable, another issue completely missed by the sports surgeon. This loose ligament will allow the joint to move excessively, causing more wear and tear injuries to that structure, which over the long haul can lead to arthritis. Her ankle was also unstable, another overlooked significant issue for a gymnast. Finally, the joints in her back were also injured. Dr. Schultz injected the patient’s own super concentrated blood platelets into her toe joint and ligaments and injected the growth factors isolated from those platelets (platelet lysate) into the low back facet joints and around that irritated L5 nerve. This is an e-mail he just received from her father:

From: Eberts, Kirt A
Sent: Monday, November 16, 2015 4:29 PM
To: John Schultz
Subject: Status Update – Sarah Eberts

Hi Dr. Schultz,

I wanted to write you about the good progress my 12-year old daughter has made since you treated her left back facets and MTP1 joint on her left foot on 10/28. She took one week off of all gymnastic activity, mostly because it hurt to walk after the foot injections (crutches were a life saver going through the airport). When she resumed she went slowly and this past Sunday she was able to do a “mock” competition in all the events – with no pain whatsoever!

So after only about 2.5 weeks post treatment she is able to perform all her gymnastics activities. Previously, as you know, we struggled for months. This puts her in great shape to get ready for competition in January. I wanted to thank you again for bending over backwards to get her in so quickly. You and your staff are amazingly talented.

Best regards,

Kirt Eberts

So not only was Dr. Schultz able to help diagnose what was really wrong by looking at the whole athlete and spending more than 2 minutes performing an exam, he was also able to use precise injections of this gymnast’s platelets to help her mend herself. So after months spent in boots, casts, and in rehab to no avail,  we were able to provide a quick way to get this particular athlete back into the sport she loves! In addition, we believe it was no accident that she kept injuring her toe and heel, because an irritated nerve in the back will cause the muscles in the leg to fire in weird ways, removing their natural ability to protect the foot and ankle.

The upshot? All too often our modern surgery specialization system and the ever shrinking amount of time devoted to each patient results in problems being missed. We have set our practice up in a way that allows the doctor to spend a solid hour of face to face time and we look at all aspects of what might be going wrong in the body of an athlete, not just the bright shiny object of the area that hurts!

The post Gymnast Foot Problems: Could It Be Your Back? appeared first on Regenexx®.

When Trudy first walked into the office I’m not ashamed to say that I was overwhelmed. Not only did she want to know how to get off migraine medications, but also how to get off other meds she was taking for her neck, back, shoulders, and knees. She could only stand for 5 minutes before needing to sit and yet had aspirations of returning to ATVing around the beautiful trails of Montana. Was it possible to use regenerative medicine techniques to get this poor disabled woman this far?

Getting Off of Migraine Medication is About What’s Really Causing the Headaches

Most patients believe that once they get a diagnosis of migraine headache, it means that their headaches are caused by vascular problems in the brain. The truth, like many things in medicine, is always a bit more complex. More common is a neck problem that sets that migraine headache storm off in the brain. So like many patients taking migraine headache medications, Trudy’s advanced hands-on exam showed that her neck was causing her headache problem.

Most headache sufferers (and many neurologists) don’t realize that the upper neck facet joints refer pain into the head. Combine that with the fact that fewer and fewer doctors are being trained how to inject these joints under x-ray guidance and patients like Trudy often go undiagnosed. Trudy also had multiple neck disc bulges and a backwards neck curve.

Regenexx-SCP A Superior Form of Platelet Rich Plasma / PRP

Her Headaches were Just Part of the Problem

However, that was only the beginning of her issues, as her MRI images later showed spinal stenosis in her back, a slipped vertebra, disc bulges in her upper back, and knee arthritis. Since she also had very little stabilizing muscle left in her back, I was really concerned that she might be too far gone for us to help, but I could see I was her only hope so I agreed to try an experiment. I injected highly concentrated platelets (much higher levels than 99% of practicing physicians can muster) in her knees to see if she would respond to anything. Much to my surprise and her delight, it worked to dramatically reduce knee pain and improve her function. At that point I agreed to tackle the rest of her problems.

Her low back was a big challenge, as in order to return her to that ATV riding that part of her body needed to come into line, as she would throw it out by riding over bumps. Again, most patients and surgeons don’t realize that the ligaments that compress the nerves (ligamentum flavum or LF) in the low back are connected to other ligaments that can be tightened through injection. When these secondary ligaments are tightened, often the LF is no longer able to place pressure on the nerves and the patient can stand for longer. So rather than cut out these ligaments and the bones in a massive surgery that might destroy her back forever, just simple injections as above aimed at the ligaments, joints, and nerves got her from just 5 minutes of standing to just over an hour!

Getting Back to What She Loves

While we also worked on her knees and other areas, when I saw Trudy back this week I was dumbfounded. She was not only able to reduce migraine headache medication and stand for more normal periods of time, but she was also back to riding her ATV with her husband! This was something that just a few months ago was off limits.

The upshot? Trudy is one of those patients that surprises me. When I first evaluated her I thought we had little chance of being able to help her reach her goal because her imaging and exam were that bad. However, it just goes to how me that sometimes aggressively treating multiple areas using the patient’s own blood platelets and stem cells with precise imaging guidance will produce results that will amaze not only the patient, but also the doctor!

The post How to Get Off Migraine Medications: Trudy’s Story appeared first on Regenexx®.

We’ve been injecting stem cells into low back discs longer than anyone else on earth. One of our early patients was a young man named Jacob who I’ve come to know well through the years. After a successful first disc stem cell injection in 2009, he recently had two new discs that needed treatment. I was sincerely hoping that our patented disc stem cell procedure could make a difference, but we were in unknown territory. Yesterday, I got an early Christmas present in the form of an e-mail about his progress.

What is a Disc Stem Cell Injection?

Eleven years ago, I came across a research paper showing that a low back disc could be regenerated in a rabbit. It was pretty exciting because we had spent so many years injecting harmful steroids into the low backs of patients and only managed their pain and sciatica. We knew based on existing studies that all of these steroid shots were likely harming the patient as the years wore on, but we had nothing better to offer. So you could see why this paper was a game changer.

In 2005, after going through an approval from an Institutional Review Board (IRB), we began a series of studies to see if injecting stem cells into the discs of low back patients would have the same effect. It took awhile for us to get this right, as our first attempts at regenerating severely degenerated discs with a same day stem cell injections showed little results. Even injecting much more advanced culture expanded stem cells showed little promise, despite what the animal models had shown. Finally, after going back to the drawing board to better understand what science knew about low back disc problems, we honed in on a solution that could reliably get rid of disc bulges. This was an injection into specific regions of the disc using stem cells that were specially cultured to select the portion of the population that could withstand the harsh environment.

Jacob’s Low Back Journey

Jake is a patient I met more than 10 years ago, who injured his low back in a car crash while in his 20s. While treating Jake I watched him mature from a unruly college kid who had just relocated from the Midwest to beautiful Colorado to the head of household. During that time, as he became a working accountant, like clockwork Jake would show up to get his low back injected with epidural steroids. I could help him for awhile, but as our practice advanced to ditching the steroids in select patients in favor of using the growth factors isolated from their own blood platelets, the amount of time between injections lengthened.

Back and Neck Surgery Alternatives

Then around 2009, the number of these injections he began to need escalated. Feeling comfortable that we had perfected the procedure, I finally offered him a disc stem cell injection. My focus of treatment was a large disc bulge with a tear at L5-S1 that he had developed. With that kind of mechanical pressure on the disc, even the platelet growth factor epidurals couldn’t keep up. He had a disc stem cell injection in late 2009, and by early 2010 was doing great. His post-injection MRI showed that the disc bulge had gone away, so at that point he didn’t need much other than his medical marijuana, a big thing here in the land of the “Rocky Mountain High”. This was fine, as his wife Patty dutifully managed all of this for him.

The Pressure is On…

Earlier this year, a follow-up MRI some 6 years after the first procedure demonstrated that while the injected L5-S1 was doing great, two discs above had developed bulges with tears. Jake had so much confidence in the disc stem cell injection procedure that he decided that he wanted to travel to Grand Cayman to get this done. This was new territory, as we had never injected so many discs in one patient. In addition, I had grown very fond of Jake, his wife, and his family, so I personally felt responsible for making this second procedure successful. However, as every physician knows, despite doing your best sometimes, there are some things you sometimes can’t control.

To add to the pressure, my wife and I ran into Jake and his wife one night on the beach in Cayman. Jake just knew that this was going to work, but I tried as much as I could to provide realistic expectations. In addition, since his narcotic use had escalated with these two new disc problems, he was counting on this procedure to get him off of those nasty drugs. So, the weight on my shoulders got a bit heavier that night.

My Early Christmas Gift

Jake’s back was injected in November around Thanksgiving time. I crossed my fingers and did everything I could to precisely place these special stem cells into the damaged parts of his low back disc. However, since this was new treatment territory, would this work?

Last night at dinner with my family, I got the e-mail below from my assistant, Bridgette:

“Dr. Centeno,

I spoke with Jake S today, he wanted me to pass along a BIG THANK YOU!! You have fulfilled his Christmas wish.  After 7 days, he was able to discontinue the narcotics and there is NO PAIN!! He is able to touch the floor with no pain.  He wanted to let you know how awesome you are and you’re a miracle worker!!”

I was ecstatic! At this point in my life, I don’t ask for much for Christmas as I usually just buy what I want, so I’d rather my family give me gifts from the heart-letters, cards, or things they make. While many patients get me gifts, the ones I love the best are when they tell me how our patented procedures have changed their lives. That’s why I’m still a doctor, after being in a position for many years where I really didn’t need to continue to practice medicine. So in a very real way, this was an early Christmas present for me!

The upshot? I’m very happy that Jake and his family this holiday have something to be joyous about and that I was able to come through for him. It’s hard to understand the responsibility we doctor’s personally feel for our patient’s well being. So much so that often the best Christmas presents we can receive are knowing that our best was good enough to change a life!

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. 

The post My Disc Stem Cell Injection Early Christmas Gift appeared first on Regenexx®.

CrossFit Pro Matt Chan from Doug Orchard on Vimeo.

Multiple meniscus tears, herniated discs, sciatica in the leg and ankle, shoulder injuries—Matt Chan has run the gamut when it comes to fitness-related injuries. However, as a professional and competitive CrossFit athlete, long recovery times and the inability to return to full function, common with traditional surgeries and treatments, wasn’t an option for him. He needed an CrossFit injury recovery that would give him a competitive edge. Enter Regenexx and advanced interventional orthopedics…

CrossFit Athlete, Competitor, and Professional Trainer

Matt is a seminar staff trainer for CrossFit, Inc. and has participated in six CrossFit games, taking second place (out of 175,000 participants) in the 2012 games. He spends a big part of his life training (for both professional and competitive purposes) in his 1,000-square-foot gym located inside his garage on his property in Colorado. He had the following to say about CrossFit prior to his injuries:

“I found that not only did it make me feel good…but also my athletic prowess was unmatched by anything I’ve ever done before. I saw what it did for my life…I felt physically more prepared for any and all activities somebody could throw at me. I looked at life like a challenge; you know, what should I get involved in next?”

Injuries Happen in Fitness

As with any highly competitive and intense fitness routine, injuries are likely to happen, and Matt has had a lot due to massive amounts of stress and fatigue on his body.

In 2012, after experiencing incredible knee pain that hurt when he did almost anything, he had an MRI done on his left knee. The diagnosis? Multiple microscopic tears in his meniscus. While meniscus tears can be a normal part of aging, this wasn’t the case for Matt. His were fitness injuries, and he knew he needed some sort of nonsurgical intervention to help him return to top form:

“It’s important for me to keep all of my body’s materials, I don’t want to cut things. I don’t want to clip things…clipping my meniscus was a bad option for me because it was always going to limit my performance in the long run.”

So Matt needed a CrossFit recovery path that would allow him to outperform his competitors, who often opt for surgery and end up out for the season. He needed something that allowed him to keep training hard while was treated.

Meniscus Treatments Without Surgery

Matt’s physical therapist recommended Regenexx where he discovered that he was a candidate for stem cell treatments that could treat his meniscus tears, and, most importantly to Matt, he would be able to keep everything that his body naturally had. Nothing clipped, nothing removed, and in Matt’s profession, this was imperative.

Matt received the patented stem cell injections, using his own stem cells, to both of his knees, followed by PRP injections. He states in the video that after two months, his knees “felt like they were brand new again.”

Herniated Disc Treatment Without Surgery

In 2014, Matt then herniated three discs in his back and had sciatica in his left leg that ran all the way down to his ankle. He again sought out Regenexx, and this time he received our fourth generation platelet lysate injections in his back. Within a month his symptoms were gone, making him feel like a whole athlete again, and just a month following his treatments he demonstrated a 300-pound power clean and jerk (see video above):

“I had my last treatment with Regenexx on January 20 and today’s February 24…just knowing that I haven’t lost any ground with this stuff—you know, a 300-pound power clean and jerk—it’s really reassuring that I can go get treated, do a bit of rehab, and not lose much fitness.”

Matt’s statement that he hadn’t lost any ground with a Regenexx procedure is key. He was in the midst of training and back surgery was out of the question. Even a stem cell injection in his disc would have caused him to loose ground on his quest for ultra-elite fitness. So our doctors decided that the most minimally invasive thing we do (inject our advanced 4th generation platelet lysate around his irritated nerves) was the way to go. This caused very little soreness and allowed him to be in the gym the next day. So if you wonder why Regenexx treats so many elite athletes, this is a great example of how our broad spectrum of regenerative treatments allows us chose a therapy that best fits their rigorous training schedule. That just doesn’t happen at one size fits all, magic stem cell clinics.

The upshot? We may not all be competitive and professional CrossFit trainers, but the fact that stem cells have such a powerful impact in a full-time fitness enthusiast speaks to the potential of stem cell treatments. In Matt’s case, his recovery time was minimal, he was able to maintain his elite fitness and activity level, and he was able to accomplish it all without surgery!

The post Injury Recovery in CrossFit Athlete: Finding Relief in Stem Cells and PRP appeared first on Regenexx®.

Every doctor sees patients who, right off the bat, he or she knows are a huge challenge. Valerie was one of those patients with one of the most severe cases of TMJ I have ever seen. She was unable to eat solid or soft foods at any level, and I was pretty sure she also had severe neck injuries that had gone undiagnosed. Ultimately she got her life back through highly precise TMJ stem cell therapy as well as a novel first of it’s kind therapy in her neck.

What Is the TMJ, and What Can Go Wrong?

The temporomandibular joint (TMJ) is the hinge joint at the jaw that you use to eat and chew. In mild TMJ syndrome, patients notice intermittent pain in the joint in front of the ear or in the muscles around the joint when talking or chewing. The joint has four key components with two that are often missed even by expert TMJ physicians, surgeons, and dentists.

First, like any joint, the TMJ has cartilage inside that serves as a protective cushion where the bones that make up the joint meet. In addition, like the knee, there is a natural spacer in the joint known as the “disc” (articular disc of the TMJ joint). This is a meniscus-like structure that moves in predictable ways as you open and close you jaw and that provides further protection for the joint due to the immense loads that can be generated with chewing. Like any other joint in the body, the cartilage or spacer can be injured or become damaged due to wear and tear leading to painful arthritis.

The next key component of the joint is the muscles that help to move it. There are many different ones including the masseter, the large temporalis that comes from the side of the head, the pterygoids, and strap muscles. The muscles work together in a symphony of millisecond-timed precision to open and close the jaw. These are powerful muscles that can develop trigger points like any other muscle—areas that are shut down and painful. These muscles also have tendons that attach to bone, so these areas can develop tendinopathy—or small tears and degeneration which can cause them to become painful.

The final two key components are often overlooked by TMJ experts, and they’re key to why we were able to help Valerie with precise TMJ stem cell therapy. These are the ligaments that stabilize the joint and how the TMJ fits into its regional ecosystem in the body—the head and neck.

Ligaments stabilize joint by acting like pieces of duct tape that guide it and prevent motions for which it wasn’t designed. The TMJ has many ligaments that often get ignored by medical providers. These are the sphenomandibular, stylomandibular, and capsular ligaments. In addition, the tough covering of the joint (capsule) is further divided into collateral (lateral) ligaments, similar to the knee.

Finally, most TMJ providers focus on the bright shiny object of the TMJ itself, forgetting that it’s a joint that lives in the ecosystem of the head and neck and that it can’t work efficiently without it’s neighboring structures working well. So neck problems will place more pressure on the TMJ joint. In addition, if the neck is unstable because its ligaments have been injured or the small muscles that stabilize it are off-line, then the body attempts to use the TMJ muscles as accessory stabilizers of the neck. Given that the joint and its muscles aren’t designed to handle these extra loads, it eventually breaks down, and the muscles get overwhelmed. To learn more about how ligaments and muscles stabilize the neck and back, read our book Orthopedics 2.0.

Valerie’s Nightmare and Eventual TMJ Stem Cell Therapy

When I first evaluated Valerie, in December of 2014, she had a history of issues with her TMJ since age 18, and she was 60 at the time. It all began with having her wisdom teeth removed as a teenager, and then five years ago, her teeth got stuck on something and she felt intense and then progressive TMJ pain. In her past she had also suffered from whiplash and head injuries. More recent was a fall that fractured a low-back vertebra and injured her SI joint. In addition, a yawn earlier that year had dislocated the TMJ, further exacerbating her issues. She was on a liquid-only diet, forced to blend her meals and drink them. She had tried every TMJ treatment under the sun without much relief.

When I first met Valerie and looked at everything from her low back to her neck to her jaw, I have to admit, I was a bit overwhelmed. So I cautioned her that while I could treat the whole picture using ultra precise TMJ stem cell therapy injections under ultrasound and fluoroscopic guidance as well as platelet procedures in many areas, given that she couldn’t even chew soft foods, I didn’t know how far we would get. Over the ensuring year and a half, we treated the TMJ joint and discs; all of the TMJ ligaments above, including some on the inside of the joint; damaged facet joints in the neck; neck ligaments; her SI joint; bulging and painful spinal discs; and then finally her alar/transverse ligaments. The final treatment was really what I feel helped her recover the most, and this procedure to treat the ligaments that hold her head on (alar/transverse) was developed by me only a few months before she tried it.

The head is held on by strong ligaments. These connect the upper two neck bones to the head and are called alar and transverse ligaments. We know from a few studies that they can be stretched in whiplash injuries or when there’s a blow to the head. These patients often have headaches, a heavy- or tilted-head feeling or appearance, problems thinking and concentrating, and other symptoms. The surgery to fix this issue is an upper cervical fusion which is a huge and high-risk affair, with many patients avoiding the procedure due to fear of major complications.

In Valerie’s case, while she was making progress with each successive procedure, I felt that laxity in these important head-stabilizing ligaments was causing her body to use the TMJ and its powerful muscles as secondary stabilizers, causing the joint to break down. In other words, we would never be able to fully get her better without also treating these upper neck ligaments. I ordered a moving stress X-ray of the cervical spine called a DMX, which did confirm that the alar/transverse ligament complex was lax and not protecting her upper neck.

Injecting into these ligaments with stem cells to help them heal and strengthen has been impossible until recently. They can’t be accessed from traditional ligament injections that come from the back of the neck as the spinal cord is in the way. I had been thinking for years that there had to be a way as we had many patients who had sought us out for our rare expertise in injecting upper neck joints (C0–C2) and posterior ligaments with fluoroscopy. Then one day, while staring at a model of the upper cervical vertebra and its ligaments that we have in the office, it hit me. There was a small hiatus (medical speak for hole) in the front of the spine between C1 and C2 that could allow a needle to be passed using fluoroscopic guidance through the front and into these ligaments. After about a year of planning and consulting with colleagues, in September of last year, Valerie was one of the first patients in the world to have her own stem cells injected into her damaged alar/transverse ligaments (or anything else for that matter given no physician had ever injected these structures).

So how did Valerie do? I recently pinged her via e-mail because I am giving a talk on this novel, ultraprecise injection of the alar/transverse ligaments in Florida next week. This is what she wrote back:

Hi!

Wow! Given Val was one of those patients who I really had my doubts I could help, what a great way to wake up on a Saturday morning! We all take for granted the little things that when they’re lost can be devastating—the ability to walk, talk, run, or chew.

The upshot? There’s more to TMJ stem cell therapy than injecting magic stem cells into the TMJ joint or starting an IV. Not only does it often take precise injections into the joint, but also into obscure ligaments and oftentimes the neck. For Valerie, it also took a new procedure that was developed based on the need to have a treatment for ligaments that had never before been injected!

————————————–

After I posted Val’s story, she sent this e-mail to elaborate on the results from all of the different body areas we treated:

“You might want to add that I have been completely rebuilt by your Regenexx treatments. I am straighter, sturdier and have much improved mechanics than I ever thought would be possible, even before I broke my back and dislocated my jaw. I barely even have a click in my jaw that I have had since age 16. And, I am taller 🙂

The post TMJ Stem Cell Therapy: Valerie’s Story appeared first on Regenexx®.

Alar Ligament Treatment Dr Centeno Lecture at AAOM 2016

Due to our high level of expertise in the field, for many years, our practice has collected a group of patients with upper cervical (CCJ) instability. This awful problem has been very difficult to treat, but the patients have been generally happy that any physician knows what’s wrong with them and is willing to do something about it. However, for years I’ve known that there was more that could be done, but there was just no way to get it done. This is the story of a new injection technique (alar ligament treatment) we now use to help these difficult-to-treat patients.

The Upper Cervical Spine and CCJ

The uppermost neck is called the craniocervical junction (CCJ). It includes the skull, which sits on the atlas bone (C1 vertebra), which sits on the axis bone (C2 vertebra). So the CCJ is the skull though C2.

As we develop in the womb, the upper neck and head actually develop as one unit. Hence your brain doesn’t differentiate one from the other when it comes to deciphering pain signals. Hence, patients with upper neck problems often experience headaches.

The upper neck has facet joints, just like the rest of the spine. These normally finger-sized joints are larger than usual and are actually the biggest spine joints. The C0–C1 joint facilitates a head-nodding motion, and the C1–C2 joint allows for 50% of head rotation. In fact, the C1–C2 facet joint is the most mobile joint in the spine.

The C1 and C2 vertebrae fit together like a complex puzzle. There’s a projection on the C2 bone (called the dens) that sticks up and acts as a pivot point for the C1 bone. The skull then fits together with the C1 bone with two projections from the bottom (occipital condyles) that sit into the C1 bone.

The Ligaments That Hold This Area Together

Ligaments are like duct tape that hold the bones together. In the CCJ, the two main ligaments are the alar and the transverse. They literally hold your head on.

The alar ligaments (blue in the image to the left) come up from the dens and connect the C2 vertebra to the skull. The transverse ligament (red) acts as like a seat belt for the dens. These ligaments stabilize the upper neck when you look down, turn your head, or do both.

What Happens When These Ligaments Get Injured?

Any ligament in the body can be injured in two ways—it can be broken in half and can snap back like a rubber band (known as failure), or it can stretch and get partially torn (subfailure). In the case of the alar and transverse ligaments, the former type of ligament injury is much more common. This means that the upper neck bones become unstable and move around too much. Just like other areas of the spine, when this happens the facet joints (in this case C0–C1 and C1–C2) can be beat up by that movement, leading to arthritis. The muscles and tendons that should stabilize this area become overwhelmed and injured. Finally the nerves can become irritated.

What Causes These Injuries, and What Are the Symptoms?

Injuries to the alar and transverse ligaments can occur with head trauma. Through the years I’ve heard many ways that these areas can be injured including the following:

• A rear-end car crash, especially one where the head hits the back window (e.g., a pickup truck)
• A sudden jolt to the neck/head
• Something falling on the head
• Placing axial loads on the head (e.g., one patient who performed a neck exercise by arching his back to place his whole weight on the head)

Patients usually complain of headaches; dizziness/vertigo (but not always); visual disturbances; disorientation; and/or problems thinking, concentrating, or reading. The symptoms are usually worse with head turning or looking down. There may be clicking or popping and activity such as exercise or physical therapy usually makes the problem worse. Very specific upper cervical manipulation (i.e., by an experienced upper cervical chiropractor or high-level manual therapist) can provide temporary relief.

What Alar Ligament Treatment Is Available for These Patients When Conservative Care Fails?

Many different kinds of injection therapy can be attempted in these patients, but few of them yield any long-term or “home run” results. Through the years, we’ve tried traditional cervical facet injections at C0–C1, C1–C2, and C2–C3. We’ve tried platelet rich plasma (PRP) and stem cell injections into the joints as well. We’ve also tried injecting the ligaments in this area (prolotherapy, PRP, and stem cells). All of this only provides either temporary or small amounts of relief. The same holds true for alternative therapies, including acupuncture, massage, body work, craniosacral therapy, etc…

The big problem with all of this treatment is that there has been no way to get at these ligaments. When coming from the traditional posterior (from the back) approach, the spinal cord is in the way. Several years ago we began to wonder if there was any way that these ligaments could be accessed.

Why is an Non-surgical Alar Ligament Treatment Important?

The most common surgery offered these patients when conservative and injection-based therapies fail is CCJ fusion. While there may be patients who have such severe CCJ ligament injuries that only bolting together the bones will work, as I tell my patients, “Fusion is a dog with fleas.” This means that fusing any segments of the spine will result in the spinal segments above and below getting overloaded and degenerative. Just take a look at the X-ray here to get a sense of why a CCJ fusion should be avoided if possible.

Getting at the Alar/Transverse Ligament

I spent several years occasionally noodling this problem. This then progressed into about a year spent focusing on how to make this work. I figured out a few posterior approaches to the ligaments, but they all seemed to work better in theory than practice as the spinal cord was always in the way. Then one day I was playing with a model of the upper cervical spine we have in the office. I noticed that the model had a little hole between the C1 and C2 bones. Could it be possible that a needle could be placed through this “articular gap”? Theoretically it should be possible, but nobody had ever attempted this procedure.

I spent the next year researching this approach, reviewing anatomy texts, and consulting with high-level colleagues to ensure this procedure would be possible. In February of 2015, I was ready, and given that we had a collection of these CCJ instability patients that had failed everything, it wasn’t hard to find a patient who had been living with this nightmare collection of symptoms.

Before the first procedure, we had many questions. Was it possible that this “articular gap” was a figment of the imagination of anatomy textbooks and models and wouldn’t allow a needle through? Was there some other reason that this couldn’t be done? Thankfully the first procedure went well, and we soon found out that this “articular gap” was for real. We got a very thin 25-gauge needle into this gap and then into the alar/transverse ligaments from the front. A blue-collar guy who had years of headaches after a car crash, who I couldn’t help in any way, told me that while he was sore for two weeks, one day he noticed a dramatic improvement and most of his headaches went away.

More Experience with This First-of-Its-Kind Procedure

Over the last year, as the video discusses, we were able to treat seven patients in 10 different procedures. All of these patients (except one who was not worked up by us) had failed all other treatments. Five of seven had excellent results for the first time ever, with many logging dramatic results. Examples included a patient who couldn’t sit in meetings who can now have one-hour meetings with a several-minute break and do this all day. This same patient can now cross-country ski for the first time in years. A patient who couldn’t sit in a car without her upper neck “going out” e-mailed that she went on a multimile backpacking and hiking trip! She had been treated by us for a decade with only small, incremental improvements.

Of the two patients who didn’t respond, one had a suboptimal injection (before we had perfected the procedure) and another had a poor diagnostic work-up before seeing us. In that patient, his pain was actually coming from an injured C1–C2 joint, which we later discovered (i.e., CCJ instability was not the problem that was driving his symptoms).

Above is a video that goes into this topic in much more depth. It represents our first public presentation of this technique at a medical conference, which occurred this week at the annual AAOM meeting.

The upshot? Alar ligament treatment is feasible and seems to give home-run results in the patients who had failed many other therapies. We’ll now move from seeing if this procedure is feasible to more formal study of the results when many more patients are injected. The meantime, I’m grateful that we now have a way to help these poor patients with this awful problem.

The post Alar Ligament Treatment for CCJ Instability appeared first on Regenexx®.

Dr Centeno Epidural Steroid Injection Alternative Lecture AAOM 2016

My patients’ epidural steroid injection reviews through the years have been mixed. On the one hand, the injection can help prevent the need for surgery; on the other, the side effects can be big and awful. Hence, a few years back, we invented a new approach using platelet lysate to replace the steroid. This is the video I prepared from a talk on the topic I gave this past weekend at the American Academy of Orthopedic Medicine in Florida.

What Is an Epidural Steroid Injection?

An epidural steroid injection is a precise image-guided shot usually given to help an irritated nerve in the spine. The average patient receiving this injection is someone who has a herniated or bulging disc that’s putting pressure on a nerve or intermittently irritating a nerve. They are also given to patients who have a leaky disc or a degenerated disc.

The shot involves injecting high-dose steroids (about 1,000,000 times physiologic) into the area around the nerve (epidural space). The injection can be effective in helping reduce back and leg pain.

What’s the Problem with High-Dose Steroids?

As the video shows above, the high-dose steroids injected can lead to issues. For example, one study showed dramatically increased bone loss in older women per shot. Others have shown everything from problems with blood sugar control due to impacts on cortisol levels to an increase in the rate of failed hip replacement due to infection. The bottom line is that the big steroid hit is not healthy.

Is There a Better Way?

Quite some time ago, we began substituting the high-dose steroids with platelet lysate, a natural growth-factor cocktail made from the patient’s own blood by breaking open the platelets in PRP (platelet rich plasma). Through the years, we’ve tested this in different ways in our registry, including against the results of epidural steroids. What we found was better results when using platelet lysate. The video above goes into more details on the two different groups on which we’ve reported data (a comparison to epidural steroids and a much larger group of 662 patients).

Is There a Better Platelet Lysate?

We’ve also spent the resources in our state-of-the-art, on-site research facility to optimize platelet lysate and have created third- and fourth-generation versions of the process that maximize growth factor levels and cell response. As with anything we do at Regenexx, we’re constantly studying whether or not we can improve the process.

The upshot? When it comes to epidural steroid injection reviews, platelet lysate gets five stars. In addition, our third- and fourth-generation platelet lysate has revolutionized our practice and that of many of our network physicians. I’ll never forget one Regenexx network doctor who came up to me at our national meeting last year. The doctor had been pretty skeptical that Regenexx could improve the tools he was already using, but he had been nudged into the network by his partner who understood the value. He looked me in the eye and said that as an interventional spine physician, no other tool that he had used in his career had revolutionized his patient care like platelet lysate. It was pretty gratifying to see this particular doc get turned around and for that 180 to help many more patients than I could have ever treated on my own!

The post Epidural Steroid Injection Reviews: Is There a Better Way? appeared first on Regenexx®.

Every physician has patients who challenge his or her skills, and it’s the reaction to those patients that determines what kind of doctor that physician is —Chris was one of those patients. She would tell me consistently that “my neck goes out all the time,” but every tool I had to use couldn’t seem to really put a dent in that phenomenon. In fact, it wasn’t until I invented a new procedure to get access to obscure neck ligaments that hold the head on that things changed.

What Does “My Neck Goes Out” Even Mean?

Like many MDs, for most of my career, the concept of BOOP (bone out of place) has been a bizarre and even threatening one. However, all of that changed when it began happening to me. So why does a patient saying “my neck goes out all the time” sound crazy to an MD?

We MD physicians can be arrogant bastards when we don’t know what we don’t know. Meaning that for any professional, there’s the world of what you know and the world of what you know you don’t know. However, what blindsides you is if the stuff you can’t fathom exists. BOOP is in that place for an MD.

The idea of a neck or back “going out of place” seems foreign to us because in our world, we were taught that instability is a binary concept (a joint in the body is either stable or unstable). If it’s stable, it’s fine; if it’s unstable, it will fall apart on its own or that instability is easy to see on X-rays or on an exam where you try to move the joint.

An example of this binary thinking about instability is an anterior cruciate ligament (ACL) in the knee. Surgeons often consider an ACL to be “intact” or “ruptured,” a binary concept like “on” or “off.” However, the ACL, like any ligament, is made up of hundreds of thousands of individual fiber bundles, and it, of course, can be “loose” when some of those fibers are injured and some are left intact. However, this frankly flies over the heads of most surgeons, who were never taught to think that way. As a result, BOOP sounds like alternative-medicine mumbo jumbo to them. If a spine bone were “out of place,” it should be dislocated, and that would be easily seen on an X-ray as some catastrophic misalignment. However, in this case the surgeons don’t know what they don’t know.

Prima Facie Evidence That the Neck and the Back “Go Out”

These past few years, I began to understand what patients tell me when they say, “My neck goes out all the time.” First, I began to experience “crepitus” in my neck and back, or what feels like the spine bones are “moving.” These abnormal movements can certainly lead to episodes that cause severe pain. So what’s happening as interpreted by a physician who knows the spine research? The term is called, “degenerative instability.”

My neck and back ligaments are getting loose as the discs degenerate with age as well as a lifetime of wear and tear. In addition, the small muscles built to stabilize the spine are intermittently getting turned off, leading to even sloppier movement. Hence the individual spine bones (vertebrae), stacked one on the other, can get into awkward positions where a spinal nerve gets pinched or a facet joint or disc gets suddenly damaged. This is what my patients have been relaying through the years when they tell me things like, “My neck goes out all the time.”

Chris’s Neck-Instability Story

Chris has been a patient of mine for more than a decade. In that time, she has told me many times that her “neck goes out all the time.” Early on in her care, when I didn’t know personally what that meant, I at least knew that what she was describing was some type of instability. Over those years, we tried countless physical therapy visits for strengthening and manual medicine. She also tried chiropractic, massage, acupuncture, trigger-point dry needling, trigger-point injections, etc. I also injected her neck many times with prolotherapy-type treatments meant to tighten loose ligaments as well as injections around nerves (epidurals) and into painful joints (facet injections). While some of this helped, nothing really changed her instability.

Alar Ligament Treatment Dr Centeno Lecture at AAOM 2016

“The back of mouth injections have helped a lot, much more than anything else, including other injections you’ve done.   

So what Chris describes is that after a honeymoon period and then after an adaption period where her muscles had to relearn how to deal with a more stable upper neck, this procedure has been a game changer for her.

The upshot? Happy Mothers Day to Chris! The idea that your neck or back can go out is a real thing due to instability and loose ligaments. While oftentimes this can be taken care of by chiropractic or other types of manipulation or simple shots to tighten ligaments (prolotherapy), that only works when the area is stable enough to hold or you can reach those ligaments. When the ligaments are like the ones that hold the head on, then new procedures must be invented to get access to them. In Chris’s case, finally reaching those ligaments after more than a decade of other treatments has made a big difference!

The post Her Neck Goes Out All the Time: Definitive Treatment? appeared first on Regenexx®.

This week, while I was performing a procedure on another patient, Dr. Bashir poked his head in to let me know of his great success with a chronic disc pain patient. It was an impressive 95% improvement in a patient who had tried it all and was now back to golf after a stem cell injection into the disc. As he told me about this, I thought that this would be a great way to illustrate why fibrin treatment for back pain to seal the disc in most patients with chronic back pain makes little sense.

Understanding the Disc

The first thing you have to understand about the disc is how it’s made and what it does. It’s basically a shock absorber between the spine bones that also allows motion. It has a soft inner gel (nucleus pulposus) surrounded by a tough outer fibrous covering (annulus fibrosis). As we age, the cells inside the disc lose the ability to hold onto water and begin producing less of a chemical that facilitates that function. This means that older discs can become dried out and collapse, becoming rather inhospitable places for cells to live. Add to this that the stability of the spinal segment around the disc begins to get worse and worse due to muscle atrophy and loose ligaments, and the disc can get beat up. Tears can develop in the outer covering.

The Concept of Needing to Seal the Disc

Some physicians, based on the teaching of a Texas doctor, are now beginning to offer disc-sealant injections with fibrin. The type of fibrin they’re using is sort of like natural rubber cement. You can inject it into the disc or its tough outer covering and it will “seal” the small tears and holes in the disc, preventing stuff from leaking out. The reason given for doing this is that sometimes discs can leak chemicals, which can cause inflammation and swelling around the spinal nerve that passes by the disc (a.k.a. chemical radiculitis), leading to back or leg symptoms. Hence, advocates for this procedure contend that sealing the disc prevents that from happening. In addition, they argue, if you’re going to be injecting stem cells inside a disc, sealing it first will keep those cells in that structure.

The before and after images of injecting really anything that gels up in the disc are impressive, whether that be fibrin, a same-day bone marrow stem cell procedure, or platelet rich plasma. Basically, the disc plumps up. This is because all of these things contain fibrinogen, which then causes fibrin to be laid down. However, there’s little evidence that a severely degenerated disc that has lost its height stays at the the new taller configuration. Basically, once the new fibrin is dismantled by the body (which takes a 1–2 weeks), the disc returns to its collapsed configuration. So the first thing to be cautious about is the X-rays showing the restoration of normal disc height immediately after after a fibrin or other injection, as the height doesn’t last!

Fibrin Treatment for Back Pain: More Misleading Research About Sealing the Disc

My prior blog on the Pauza Discseel™ procedure found many inconsistencies between what the website suggested and reality. The biggest was that while the website would make you believe a randomized controlled trial (RCT) had been performed that supported that the procedure was effective, in fact the only RCT performed showed that the procedure was no better than a placebo shot. In addition, the website reasoned that you needed to seal the disc to keep injected stem cells inside because stem cells can cause cancer. No research shows this, and the website erroneously points to a “respected Johns Hopkins study” without any such study actually existing. In fact our recent 2,372-patient stem-cell-safety study included patients with stem cells injected into their discs, and no such issues were found.

The website about using fibrin treatment for back pain to seal discs has so much misleading information that it’s almost difficult to know where to begin. However, this morning I’d like to highlight another study brought to light on the LinkedIn discussion board where we directed our readers to participate in the discussion about the technique.

There is a claim on the website that tries to scare patients off from using stem cells to treat their discs that states that stem cells injected into the disc can cause bone spurs to form (if they leak out). The site states that this is therefore one pressing rationale to seal the disc before injecting stem cells. This claim has issues on many levels, not the least of which is that the disc will only stay sealed for about a week to 10 days. However, like many things said on the fibrin disc-sealant site, there’s what the words superficially suggest and then reality once you take a peek under the covers.

In this case of bone spurs, the website refers to a rabbit study where the authors tried hard to get the stem cells to make bone. Cells were cultured in a special media to force them to make bone and were not the treated rabbit’s own cells, and the injury to the disc was not one that in any way replicates the real human degenerative disc disease condition. In fact, the stab model used to injure the disc before the stem cells were injected is about the same as taking a ball-point-pen-sized implement and jabbing it into your disc and sucking out all of the living cells. So unless you’ve been recently abducted by aliens and had your disc sucked out, the starting point for this experiment was nothing like your degenerated disc! In conclusion, nothing about this study is in any way like the same-day stem cell based disc injections that patients are receiving for torn and painful discs.

Our Patient

To illustrate why sealing the disc with fibrin is not needed, a great example this morning is Dr. Bashir’s patient. Ted had a multi-year history of low back back pain and had failed physical therapy and epidural steroid injections. He was so disabled that he couldn’t throw a Frisbee with his kids. His MRI had a tear in the back of the disc, and his discogram (a test where dye is injected into the disc to see if it’s painful) showed that the L5–S1 disc was painful. In addition, that test showed L5–S1 was a leaky disc in that the dye squirted right out. The L4–L5 disc was also leaking, but it wasn’t painful.

Dr. Bashir injected the patient’s own stem cells using our proprietary Regenexx same day stem cell procedure in May of 2015, and he reported 75–80% improvement. Since he wanted more, the disc was injected a second time in November of 2015. In both instances, the L5–S1 disc was injected with his own stem cells (and NOT sealed with fibrin). The patient did well and was just seen this week for his one-year follow-up. He’s now reporting a 95% improvement! He’s back to all activities and without pain, and never once did we entertain the idea that we needed to first seal his leaky low back disc.

Why did this work so well if the disc was leaking? As discussed above, a same day bone marrow stem cell procedure has its own natural fibrinogen from the patient’s own body. It seals the disc all by itself. Unlike fibrin glue, which has been shown to be a very poor stem cell scaffold because it’s too dense, bone marrow sets up its own natural scaffold for stem cells immediately upon detecting exposed collagen fibers, like those seen inside a torn disc.

The Very Real Downside of Injectable Fibrin

A few years back, we saw a woman who was a chronic dural leaker. This meant that the covering of her spinal cord (the dura) that was supposed to hold back cerebrospinal fluid (the liquid in which the brain, spinal cord, and nerve roots are suspended) would spontaneously spring leaks. She had been treated with the same type of fibrin that doctors are now using to seal the disc. There was just one little problem. Despite the product being FDA approved for being safe and free of communicable disease, she had been injected with a bad batch made from a blood donation of a patient with hepatitis C. After that therapy, she had developed the disease. While we were able to help her using highly concentrated platelet rich plasma injections instead of fibrin, she serves as a very real reminder that there’s nothing like the power of your own tissues, as even FDA-approved biologic tissues have a false negative rate when screening disease. In addition, while this is a rare event, it’s not rare if it happens to you.

The upshot? So is there a pressing need for fibrin treatment for back pain to seal the disc before injecting stem cells? Not really. Certainly nothing on the fibrin disc-sealant site sounding alarm bells of why sealing the disc can prevent catastrophe is remotely credible. In addition, cases like Ted’s show us that despite having a severely leaky and painful disc, without fibrin being injected, the right patients with a torn and painful disc do great. Finally, our dural leaker patient is a stark reminder that using your own tissue to heal your body should always be your first choice!

IFBB Pro Eileen Wells' Comeback Story - A Regenexx Stem Cell Procedure Success

Perpetual growth in mind, body, and soul is the philosophy professional body builder Eileen Wells lives by. Her everyday goal? Be better today than she was yesterday. As a professional competitor in the fitness division of the International Federation of BodyBuilding (IFBB) she was able to live by that mantra…until all of that changed in an instant. In 2014 a back injury took over her life—mind, body, and soul—and stopped her from competing and training. Thankfully, a lower back stem cell treatment got her “back” on track.

If you watch the video of Eileen’s story above, I think you will agree that the vast majority of us would consider her captivating strength and fitness abilities almost superhuman. In IFBB fitness competition, participants prepare a two-minute routine that shows off their personality, and they are judged on endurance, flexibility, strength, and overall performance. After Eileen’s back injury, not only could she not compete and train—she also couldn’t work out, she couldn’t satisfy her sponsorship (she is sponsored by MuscleEgg), and, in fact, she could barely walk at times.

Her favorite saying is, “You’re either green and growing or ripe and rotting,” and Eileen had been instantly thrust into the latter. She had no idea what to do, and when massage therapy, chiropractic work, and water therapy didn’t work, she started where most of us would have…with traditional medicine.

Eileen’s Back Injury and the Traditional Medicine Approach

The symptoms of Eileen’s injury began as stabbing pain in her low back during exercise. She also experienced numbness that traveled down into the top of her foot. An MRI displayed the troubling diagnosis: a herniated disc at S1–L5, a bulging disc at L4–L5, and above that, a cyst in a facet joint.

During her traditional-medicine route, she underwent steroid injections and began taking prescription drugs and over-the-counter anti-inflammatories to control her pain. She knew the anti-inflammatories were counterproductive and likely prolonging recovery, but without them the pain made it difficult just to walk. It was also all very expensive, as these days in our new world of sky-high copays and deductibles, even traditional medicine costs and arm and a leg. In her words:

You go to bed and hope that the next day you’re in less pain, but you’re not. After period of time, you don’t even want to be around yourself. I’m sure the people around me probably suffered with me, especially my husband. It damages you more mentally than physically for sure.

Two surgeons told her if the pain continued, her next step would be a spinal fusion, which uses screws and rods to “lock” together two or more vertebrae in the spine permanently, stopping the natural movement in that segment of the spine and leading to adjacent segment disease as more pressure is put on the segment above and below the fusion. She was also smart enough to know that few patients that get this barbaric procedure ever return to the level of fitness where she wanted to be.

Finally, a third surgeon gave her an honest answer: “Listen,” he said, “if you were my sister, I would tell you to do anything besides surgery.”

Eileen’s Lower Back Stem Cell Treatment

Eileen learned about Regenexx and stem cell injections from Carol Semple, Ms. Fitness Olympia. Dr. Pitts reviewed Eileen’s MRI and spent and hour with her in physical examination, and ultimately determined she was a good candidate for a lower back stem cell treatment. During her first procedure, we used our proprietary, high-growth-factor platelet lysate to reduce swelling around the back nerves without harmful steroids. After that, she was able to stop her prescription and anti-inflammatory drugs. Then, Dr. Pitts performed a second round of platelet lysate and added a precise fluoroscopically guided stem cell injection into her damaged low back disc, harvesting bone marrow stem cells from Eileen’s hip.

Eileen’s Lower Back Stem Cell Treatment Success and Return to IFBB Competition

She had the lower back stem cell treatment in September of 2015. The video above was filmed in May of 2016. It shows her progress from the awful disability she experienced at her low points during the 17 months she was out of commission. She had already shared her amazing lower back stem cell recovery training videos with us via Facebook and above you see her returning to the “green and growing” fitness path. Eileen shares her success in her own words below:

I was able to walk up and down stairs within 10 days. When I first started physical therapy again after the stem cell injections, I could only hold a plank for about five seconds, and now [May 2016] I can do one-arm push-ups again.

Eileen is back to her full training schedule and, the best news of all, she’s back on the competition circuit and will be competing in the IFBB PBW Tampa Pro Championships in August.

The upshot? We were the first in the world in 2005-6 to offer lower back stem cell treatment for damaged discs, so we’ve learned a lot in the last decade. With our broad spine offerings that include proprietary platelet lysates and stem cells, Eileen was able to reclaim her mantra. As she says, “You’re either green and growing or you’re ripe and rotting.” Which one are you?

Hip Arthroscopy

• Hip labrum surgery complications can make the hip unstable.
• Hip labrum surgery shouldn’t be performed based only on MRI findings and a quick exam.
• Hip labrum tears can be normal wear and tear and may not be the cause of hip pain or an indicator for surgery.
• Hip surgery won’t work if the problem isn’t really in your hip, and many times the problem is actually in the low back.
• Platelet or stem cell injections may be able to replace the surgery.

Brian’s Important Story

The upshot? It’s been a pleasure getting Brain back on track in his medical education. We found a kid struggling to walk, with his medical-school education on indefinite hold due to the side effects of hip labrum surgery, and now he’s finally finished his first year of medical school! Hopefully Brian will use this experience to motivate himself to be the kind of physician who thinks outside the box!

When I first met Tony, he was amazing in every way. At age 60-plus, he told me he had injured his shoulder while working on the rings. On the what? Turns out that the gymnastic rings were merely just another challenge for Tony to conquer, mere baby steps compared to the physically demanding and dangerous stuff he loves. How do you keep a guy like this, who places tremendous demands on a gracefully aging body, going? You get ProActive…

Tony’s Adventures

Tony is a humble guy who won’t volunteer that he’s a world adventurer and adrenaline junkie, but get him talking and you’ll be dumbfounded. Dive the deep sea while living in a decompression chamber off the back of a boat—been there, done that. Jump off buildings or into canyons—did that twice. Swim with the crocs? No problem—done that with sharks and killer whales as well! Fly a supersonic jet at the edge of space? Did that last year…You name it, Tony’s done it or it’s on his bucket list. He has a bucket list that would put most of ours to shame.

How do you keep a guy like this, who’s passing age 60 at 100 mph and not looking back, active? Regenexx ProActive! What’s that? Let me explain.

Regenexx ProActive

How can you be that guy or gal who ages gracefully and does what Tony does, or even what you love to do, well into your 60s, 70s, and 80s? Read Regenexx ProActive! The PDF of the book is available by clicking on the book thumbnail to the right.

What is ProActive?

1. Avoid surgery.
2. Optimize your diet and lifestyle.
3. Use precise injections of your own platelets and stem cells to treat small problems before they blow up into big issues that stop you in your tracks.
4. Pay attention to your body so you know the warning signs of impending muscle, joint, or nerve blowups.

How Does Tony Use ProActive?

Tony’s shoulder rotator cuff tear should have required surgery, but that would have left him less able to get back to the ultra-high-level things he loves. Hence, we treated the irritated nerves in his neck that caused his shoulder issue with his own platelet growth factors and his rotator cuff with his own stem cells—precisely placed via injection.

Tony went “all in” with Regenexx ProActive, just like he does with everything. We first identified any areas that could be problems with an hour-plus exam. We then imaged all those parts of his body with advanced MRI. We went through every tendon, joint, and ligament with an ultrasound exam. In the end, we identified parts and pieces that were either beginning to fail and cause him low-level problems or ones that were clearly going south. Our goal was to treat these small issues while they were small and avoid the major blowups that could take Tony out of the game.

The upshot? I want to be Tony when I grow up! He’s an amazing guy (and a heck of nice guy as well). Keeping him going toward his newest goal of climbing Everest and the Nepali peaks will be our next challenge. I think I have the easy part as he gets to be the guy that summits, hopefully thanks to Regenexx ProActive!

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. 

We’ve been impressed with using stem cell injections in the right kind of discs. While most patients believe that there is only one type of disc issue, there seems to be no end to the number of physicians willing to inject stem cells into discs. However, we’ve been more selective. Why? Eleven years of experience injecting stem cells into low-back discs have taught us that this is a great tool when it’s applied to the right kind of discs and a waste of money when it’s applied to the wrong type. This morning I’d like to review a patient of Dr. Pitts, who has the right type of disc, and go over some important changes in the problem disc.

What Is the Right Kind of Disc for Stem Cell Injections, and When Is It a Waste of Money?

How to Read Your Low Back MRI Report for Disc Issues

An Example of a Good Disc Stem Cell Candidate

Tracey is an active middle-aged woman with a disc tear and bulge that had persisted for two years. She had tried and failed physical therapy, acupuncture, and chiropractic care. Tracy got only temporary relief from low-back epidural steroid injections, an SI joint injection, and a radiofrequency ablation of her facet joints. Dr. Pitts initially tried using our 4th-generation platelet lysate procedure by injecting this into the ligaments, joints, and epidural, but she didn’t note that much relief. Hence, he became more convinced that her remaining pain was related to the L5–S1 disc. So in March of this past year, he performed a same-day stem cell procedure, precisely injecting her cells into the L5–S1 disc using fluoroscopic guidance.

Her MRIs are above, taken before the procedure (on the left) and then about seven months after (on the right). Notice the disc bulge in the yellow-dashed line that’s there before and then not there or smaller after the procedure. Also, note that this was a long-standing bulge that wasn’t resolving on its own, so it’s likely that these changes were caused by the injection. She also noted about 75–80% resolution of her low-back and other symptoms.

The upshot? Low-back discs, when they’re carefully selected, can respond well to expert same-day stem cell treatment. However, we see all too often that treatment is offered to any patient with a disc issue and the money to pay for the treatment. Tracey is an excellent example of a patient who needed stem cells injected into her disc to recover!

We’ve always published our outcomes. What’s bizarre is that few other clinics have followed suit. Maybe it’s because we’ve been doing this work longer than any other clinic. Now we’re upping our game again with a level of transparency that doesn’t exist for any other stem cell clinic—real-time outcomes that patients can access online.

Outcomes and Why They’re Critical

Let’s face it: despite our 11 years of experience injecting stem cells into the various areas of the musculoskeletal system, many physicians out there still think stem cells are some sort of voodoo. While we have seen less and less of this year after year, we still need to collect and publish results (aka outcomes) to convince mainstream physicians that this procedure is for real. As a result, Regenexx has published a plurality of the world’s orthopedic stem cell research.

While we’ve taken this commitment seriously, few other clinics and doctors do. Many will talk a big game, but when it comes down to it, they don’t take the time, energy, and resources necessary to collect outcomes. This list includes many academic physicians who should be doing this but can’t seem to get their act together to get it done.

Real vs. Faked or Made-Up Outcomes

One of the things we’ve seen out there in the stem cell wild west is “made-up” outcomes, which is disturbing. My experience with this phenomenon began with an orthopedic surgeon in Florida who started using stem cell injections about four years after we began. At that point, we had put up our first set of stem cell outcomes for knee arthritis, and one day I found those copied and pasted on his website. Huh? He used a completely different procedure than we did so our outcomes didn’t apply, so I told him to take them down. He did this but then promptly inserted completely fabricated outcomes. When I confronted him about these results, he admitted these were his estimates of how he thought his patients fared rather than any compilation or analysis of pre- and post-procedure data collection. Yikes!

I’ve also written other blog posts about how other physicians have estimated their outcomes. For example, one recent research paper on fat stem cells used to treat knee arthritis used an “outcome” that was two-thirds determined by what the treating doctor thought! So even if the patient didn’t report that he or she did well, the doctor could make that poor outcome look great by voting that the patient’s assessment was wrong! Nuts! No other medical specialty outside of orthopedics would tolerate such nonsense.

Regenexx Outcomes

We’ve spent years collecting outcome data and are now actively tracking more than 9,000 Regenexx patients in a registry. It takes a team of people thousands of man-hours a year to contact all of these people and send and collect outcome forms. It’s a thankless and gargantuan task.

We’ve always published these results and have updated these infographics every year. However, recently we developed an outcome app that is now used by our network providers to analyze a real-time extract of the registry. For example, our providers can pull up all of their knee patients to see what they’re reporting.

Recently, I realized that we needed to have all of this information available to patients. Why? It shows a level of transparency that doesn’t exist in medicine. Also, it demonstrates the difference between being seen in a Regenexx clinic and the rest of the clinics that offer stem cell treatment. Heck, the other clinics have no data, let alone data that you can search online and slice and dice how you want it when you want it. Here is a link to get to that new data analysis tool. We’re still working on the mobile version of this app, which should be available soon, so it’s now only optimized for computers and tablets.

The upshot? Nobody else takes outcomes as seriously as Regenexx. Nobody is even a distant second. Now we’re doing what real leaders do—when there is no competition, you up your own game!

I love the creative ways patients find to let us know that they’re doing better. This last week, I received this great shot from Dr. Pitts who had treated Agnes, a patient who had significant back pain with hiking. Here she is, having just climbed Colorado’s Mt. Elbert at 14,433 feet!  So how did we help her avoid back surgery?

What Was Wrong with Agnes?

Agnes had an annular tear on her MRI. What is this? The low-back discs have two main parts. The inner gel is called the nucleus, and the outer covering is known as the annulus. The latter has many strong fibrous layers that are constructed like an onion. It’s possible to tear the fibers of the annulus, and this can cause pain. It’s also something that can happen with wear and tear and likely doesn’t cause pain. It’s thought that these tears in the annulus lead to degeneration of the disc over time.

Given that we were the first clinic on earth to treat damaged low-back discs by injecting stem cells, we’ve learned a thing or two through the last 12 years. While it’s easy enough to inject the disc, this isn’t always the answer. First, it’s more invasive that just injecting other structures, like the area around the irritated nerves (epidural), the facet joints, or the ligaments. Second, if the patient can be made better without injecting the disc, why take the additional risks of injecting that structure? These risks include the possibility of damaging the disc and the rare possibility of a disc infection known as discitis.

What Did Dr. Pitts Do for Agnes?

Agnes was injured in a car crash. While her MRI showed an annular tear, her exam looked like she may have injured her facet joints and ligaments. The facets are small joints that help guide the movement of each individual low-back disc along with the ligaments. Dr. Pitts also suspected that these ligaments had been injured, and this additional motion allowed by now-loose ligaments may be irritating the low-back spinal nerves. All of this was certainly enough to give her back pain when hiking.

Regenexx PL-Disc: Avoid the Harmful Side Effects of Epidural Steroids and Back Surgery

The upshot? We can’t help every patient, but the wide array of proprietary technologies that we have available to us allows our Regenexx providers to treat many different spinal problems. We’re glad that we helped Agnes climb and conquer her personal summit! Hopefully, now she can put back pain with hiking behind her!

As you may recall, we’ve been using a novel CCJ instability treatment for the last two years. This procedure is different from other treatments in that we inject the alar, transverse, and accessory ligaments directly through the back of the throat using X-ray guidance. We’ve seen excellent results, but outside of updating you on a medical conference presentation here or there, I’ve stayed away from posting most patient results until we have more cases under our belt. However, now that we have used this procedure 40+ times and have a sense of what to expect, it’s time to begin introducing some of the patients who have had their lives changed. One, this morning, is Allison.

What Is CCJ Instability?

CCJ instability means that the head is not firmly connected with strong ligaments to the neck. These ligaments may have been damaged or loosened via trauma, disease, or both. The ligaments that are most commonly cited are the alar, transverse, and accessory ligaments. The problem is tough to treat, and most of these patients only get slight improvements with attempts to tighten the ligaments at the back of the neck. Others will end up with super-invasive surgeries that have very high side effects and severe injury rates.

Meet Allison

Allison is an acupuncturist who I have treated for years for injuries sustained in car crashes and through other mechanisms. I have injected her upper neck joints, the ligaments at the back of her neck, the nerves in her neck and back, and many other areas. Her upper neck had remained a mess no matter what I did. While I could get her some temporary relief in this area, just before I decided to allow her to try the CCJ procedure she told me that she could knock her head out of alignment simply by scratching her forehead!

While we did her CCJ instability treatment a few months ago, I wanted to share with you a series of e-mails she just sent as they tell a compelling story about how Allison is doing:

“Hi Dr. Centeno,

I wanted to share some of my progress with you.

While in Cabo San Lucas, I rode around in the golf cart with my husband while he played at a course called Diamante.  When I just couldn’t stand sitting in the cart anymore, I pinched some clubs from his rental bag and took a few swings.

Heeeheeee :o). It wasn’t horrible.  I didn’t feel dizzy, I didn’t get a raging headache, and the consequences didn’t extend to the next day, and the next day, and the next day… Yay!!

It did knock my C1 vertebra out to the left, but I could get it back in by shoving the transverse process back to the right.  And, it did cause some swelling in my neck, but nothing that didn’t resolve on its own overnight.

Granted, my lower back has its own issues, but as for the CCJ problems, I’m getting remarkably better.  And all after only 17 weeks!

The next time he played, he was on The Dunes course at Diamante (ranked #38 in the world).  This time I snitched some of his clubs on 3 of the holes and played the entire hole.

On the 10th hardest hole on the course, I made par.

On the 2nd hardest hole I was 1 over.

On the 1st hardest hole I was 2 over.

All this on a) rental clubs. b) on men’s stiff shafted rental clubs (I play 2 shafts down from that) c) into a 20-30 mile an hour headwind/crosswind d) after not swinging a club at all in 3 years

It felt so good to do something “normal” I actually cried.

Here are some pictures of my first swing (pitching up onto the green in a pink shirt and flip flops), and me playing the #1 hardest hole at Diamante (on the tee box in the white shirt—I even matched the distance of my husband’s drive from only 1 tee box forward. Ha!)

Thank you so much for all your help, and for all you do for the advancement of medicine.   You are a godsend!

All my best,

Allison Suddard”

“Well, I did it!  I played an entire 18 hole round at the course I told you about (The Dunes at Diamante/#38 in the world).

I’m SO excited that I could play 18 holes all at once. I haven’t done that in 4-5 years. I would usually have to stop around 10–12 holes and couldn’t even tee up my own ball.

I shot 100 (my old scores would have been in the high 80s to low 90s), but given all the factors I mentioned before, and given my starting point back at the end of October, I am ecstatic :0))).

Again, thank you, thank you, thank you!!!

Allison Suddard”

The upshot? I’m so glad that I was able to help Allison with this new CCJ instability procedure. We’ve seen some amazing results so far, and we continue to gain experience with this new technique. Hopefully, in a few years, this procedure will become routine so that we can help many more CCJ instability patients!

There are many differences between real innovative stem cell care and the chiropractic clinic Amniotic Stem Cell Scams using dead amniotic stem cells. One of those is Candidacy grading. This means that the physician offering the care has extensive data that he can reference to determine whether or not the patient is a Good, Fair, or Poor Candidate for a stem cell procedure.

Our Extensive Collected Data

Unlike Amniotic Stem Cell Scams, Regenexx tracks it’s patients in the world’s largest stem cell patient registry in the world. Run by a nonprofit organization called the Interventional Orthopedic Foundation, patients are entered into the registry at the time of their procedure and are tracked for 10 years. They are contacted at predetermined time points and are asked questions about their pain level, their function, their percentage of improvement and whether they have experienced any type of complications.  This is significant because outcome studies in Orthopedics are usually based on the Orthopedic Surgeon’s subjective opinion of how successful they feel their surgery was, rather than the patient’s objective real life experience of pain, function and outcome over time. Regenexx Physicians have access to this extensive data base to assist in Candidacy rating for all of our procedures and can see for instance, what ACL tear type, and femoral and offset measurements, resulted in the most successful results of our groundbreaking Perc-ACL procedure.

Our registry data is also available on our website in 2 Outcome formats for patients.  “Regenexx® Patient Outcome Data by Areas Treated” , has infographics detailing the results for each body area treated, and our new “RegenexxLive Patient Outcome Data” which is a live interactive platform in which you can see Percent Improvement, Pain and  2 different types of Function scores for each area treated.

The combination of our Registry data, and our ongoing research resulted in a published paper on hip arthritis patients, which brought us to the conclusion that for Hip arthritis, which is very different than knee arthritis, the Candidacy rating metrics needed to be different. We concluded that Hip patients who are over 55 and who have severe Hip arthritis are Poor candidates for the same day stem cell procedure.

A Patient Compares the Regenexx Approach to a Chiropractic Amniotic Stem Cell Scams

This was posted on our Facebook page and I think it says it all…

“Cecilia- I almost was lured in by this fake stem cell , chiropractic clinic not far from my house! Went to a lunch “seminar ” in a restaurant with a gorgeous sales guy , who was talking very fast and showing a video also very fast! So I went for the free consult! In a chiropractic clinic! Oh by the way they were the amniotic stem Cells! As soon as I walked into that clinic, I had a strange feeling. They gave me a kind of X-ray with a little machine I’d never seen before and said, I was definitely a good candidate because there was still space available, by the way it’s my left hip , which needs a hipreplacement. I thought , whooo , whooo, good news. So I went in to see the “doctor” and he was pushing me to do it NOW (wow that turned me even more off) I probably needed 2 injections (blind by the way) and the first one would cost me $5000 but I could get 2 injections for $6000 if I was willing to give a video testimony! I left that clinic and I never called them and they never got back to me!

So in the meantime I found Regenex and started to study your company for a long time and filled in the patient form and made an appointment for April 10 in Vista ,California with dr. Cohen. What a wonderful doctor and clinic! Unfortunately I was not a good candidate because of my age (72) and the state my hip was in, I would only have a 30% improvement chance and he told me , if I was his mother, he would not advise the stem cell treatment! It was a bummer off course to hear that, but I really appreciate his honesty! He said to do the operation( what I really dread and I am freaking out) because it would improve my hip and come back then for my two knees, who are not that bad yet!

So , I will have my surgery probably in October and after that do the stem cells treatment for my knees!😥”

The upshot? The Facebook comment above says it all. At Regenexx, we take this stuff seriously. At your local chiropractor’s office where you can get a dead amniotic stem cell injection delivered by a physician extender, it’s all about making the sale! Buyer beware…

Dramatic Improvement In C2 C3 Facet Joint with Stem Cells

I’ve spent the last 12 years staring at MRIs before and after orthopedic stem cell treatments. I’ve seen some incredible things in many conditions and some MRIs that didn’t change. This past week, as I reviewed the MRI of a patient with a severely degenerated cervical facet joint that we had treated at our licensed facility in Grand Cayman, I gasped. The results were truly remarkable.

Unidentified Instability Leads to Severely Degenerated Cervical Joint: C2–C3 Facet Joint

I’ve discussed before how joints can become unstable (e.g., craniocervical instability, shoulder instability, and hip instability) and havoc can ensue when it goes unnoticed and untreated. This is exactly what happened to the patient whose case study I present in the video above. The patient had been involved in a car accident and experienced a subtle instability at her C2–C3 level in her upper spine. This was not only left untreated but also unidentified. In addition, the answer to her pain, unfortunately, was multiple high-dose corticosteroid injections, and by the time she made her way to me, these injections had likely caused her severely degenerated cervical joint, called DJD (degenerative joint diesase), at the C2–C3 left facet joint, with hypertrophy. This then led to severe foraminal stenosis, a narrowing of the space the spinal nerves run through. This larger facet joint then placed pressure on the covering the spinal cord called the dura.

High-Dose Steroid Injections and/or Surgery Are Bad News

Sure, high-dose steroids, commonly injected into joints to relieve pain, are powerful drugs that may temporarily reduce swelling. Their anti-inflammatory, pain-reducing effects may last for a few weeks or months, and this is why patients feel so good after they get a steroid shot. However, the pain and inflammation returns when the steroid “magic” wears off, often sending patients rushing back for another steroid fix. Why is this a problem? Why are steroids such bad news?

First, pain relief usually diminishes with repeated steroid injections. Research has also linked high-dose steroid injections to many side effects. Their link to cartilage loss is a big one with one recent study showing progressive long-term cartilage loss and pain relief for arthritis no better than with a placebo. Steroids’ effects on bone are also a huge concern as studies have shown associations between steroids and fractures as well as bone loss.

Surgery also would have been bad news. For severe DJD, in orthopedic surgery, cervical fusion would have likely been the last-resort step here. Luckily my patient didn’t get that far. A cervical fusion involves installing hardware, such as plates and screws, to bolt the vertebrae together, rendering them immovable and oftentimes disrupting the normal curves throughout the entire spinal column.

C2–C3 Treatment Without Steroids or Surgery

We initially treated this patient with high-dose platelet rich plasma, which provided good relief of her symptoms; however, because of the severity of her facet joint arthritis, it wouldn’t last. Realizing our culture-expanded mesenchymal stem cell (MSC) treatments were going to be the best solution, in this case, we injected 1 million culture-expanded MSCs and 1 ml platelet lysate at our licensed site in Grand Cayman. This dosage is about a thousand times more MSCs than you could ever inject into the joint within a US-based treatment. We also treated her local ligaments (cervical supraspinous and interspinous ligaments).

In the video, you will see a dramatic before and after MRIs of the left C2–3 facet joint. First, to look at the before picture, let’s first review the image below. Notice that the facet joint (yellow arrow) is bigger and darker than the opposite side. The darkness means the bone is dying and stressed. The increased size is called hypertrophy. The blue arrow points to the enlarged joint putting pressure on the dura. The red arrow points to the narrowed foramen.

The after image, five months following her treatment (see video), shows her hypertrophy is mostly gone and the bone now appears normal. The left C2–C3 foraminal stenosis and the pressure on the thecal sac, the covering of the spinal cord, has also improved. There was likely still a small bit of fusion in the joint, but considering this was an end-stage joint, this is understandable. Clinically, the patient reports a 60% improvement in her pain.

The upshot? Our advanced stem cell treatments never cease to amaze me. This case, in particular, shows how powerful these procedures can be. Think about it. No surgery, no hardware, and no destruction of the tissues getting all of that done. Just a small needle placed in the right spot to inject the right stuff.

Culture-expanded MSCs are not FDA approved for use in the U.S. but are subject to an existing phase FDA 2 clinical trial. This patient was treated in Grand Cayman, which allows culture-expanded MSCs as the practice of medicine.

If you read this blog, you know that we sometimes use stem cells to treat low-back discs, but only in select patients. Being the first clinic on earth to perform disc stem cell injections, we’ve learned that they are not a panacea and they don’t work in every type of disc disease. However, when you have the right type of patient, the procedure can be a game changer. This past week, unsolicited, I was contacted by a grateful patient from three years ago, and I thought his disc stem cell outcome should be shared.

The Stem Cell Wild West and Low-Back Discs

While we have been selective in injecting low-back discs with stem cell treatments, many clinics just seem to inject any type of low-back disc. This is because, for these clinics, the hype clouds good judgment. They don’t have extensive experience in this area as they just learned how to do this at a weekend course. For a quick tutorial on the type of discs that we have seen respond to a stem cell treatment, click on the video below:

Should You Get Your Disc Injected with Stem Cells?

Robert’s Story

Robert was a long-standing patient who I had successfully treated for years. I began using our third-generation platelet rich plasma (PRP) and our fourth-generation platelet lysate to inject his facet joints and around irritated nerves (epidural). He did well for a few years with that approach and would have greatly reduced pain for about a year at a time. However, he injured his back doing something, and everything seemed to change. After that, the therapies that had been successful didn’t seem to work any longer. His new MRI showed a tear in the back of his disc, and his symptoms matched that of chronic disc pain. Hence, in 2014, I injected his painful disc using a same-day bone marrow stem cell procedure (our second-generation bone marrow concentrate). I’ll let Robert tell the rest of his story from here:

“Dr. Centeno and Staff-

It has been 3 years since stem cell therapy injection into my lower 5th disc and I can’t be happier with the outcome.

July of 2013 I was 50 years old and in a hotel room that turned into pure misery. My lower disc was radiating so much pain, I couldn’t sit in the chair without extreme pain and I couldn’t sleep on the bed. I resorted to laying on the floor and getting 3 straight hours of sleep was a miracle. Riding in the car to go out to eat was miserable. The injury to my spine from playing high school football was getting worse and caught up to me. I thought my destiny would be a wheel chair for the remainder of my life.

After my procedure last week of August 2013 I needed crutches to leave your office…After a few days I could walk around without crutches however couldn’t go far. The healing process was starting and I knew it would take a while. By December I felt like a new person. The radiating pain that I normally felt shooting out of the right side of my lower disc was a dull sensation. It would slowly go away after months and I didn’t notice it anymore. Getting dressed and putting my shoes on became easier.

Summer of 2014 I would still get real sore after doing light yard work. I tried just cutting the lawn without bending over to pick weeds. Sometimes I would get so sore I thought I was going to be back to pre-stem cell therapy condition. I would just quit and call it a day. I would only get sore if I was bending forward and using my back.

I only got better and stronger. I could actually shovel light snow winter of 2014-2015. I bought a snow blower for the driveway and only hand shoveled around the walk and entrance. I could also walk 45 minutes to an hour before my lower back would get sore.

2016 to current date August of 2017 has been incredible. I don’t feel the lump of pain coming out of my disc and I’m stronger than I thought I would achieve. I can drive my car on long trips and not worry about pain. I can do some yard work without worrying about the need for sitting down for the rest of the day with a bag of ice on my lower back.

The key to my pain management has been knowing my limits. I try not to bend over and reach for anything except putting my shoes on.

I have had to make adjustments to my athletic life. I’ve played sports and have exercised and worked out at a gym my entire life. In my 20’s I couldn’t get enough mountain biking. I still ride bikes. However I gave up the mountain bike where you have to bend your body forward to reach the handle bars. I have a street bike that is more traditional where your body is more upright. I have been riding 15 miles a day, a little more than an hour, all summer long. If I ride more than 1.5 hr’s I will start to get sore in the lower disc area.

I’m a life long golfer and had to give up golf. The pivot of the golf swing is just too much torque on my lower spine. When the fairway iron hits the ground and the golf ball at the same time, the shock wave travels thru my spine and I would get too sore. I don’t want to chance ending up with another injury so I just don’t play golf. I’m over it. I’m one big happy camper just to get a great night of full sleep and roll out of bed without pain.

I can’t thank you and your staff at the Centeno clinic enough. I am walking proof that stem cell therapy works. I wish the best recovery for all of your patients and hope they are a success story like me.

Thank you-

Robert Laine”

So Robert isn’t perfect, but he’s dramatically better than he was prior to the disc stem cell injection. In addition, like other disc patients we have treated, his improvements have continued over the first 1–2 years and even beyond.

The upshot? Injecting the disc adds additional patient risks, and we can often help a patient’s pain without taking those risks. However, for some patients, injecting the disc with stem cells is likely the best move. Given that we have more experience injecting discs with stem cells than anyone else on earth, we’ve learned a thing or two about who is a good candidate and who should avoid this procedure.