First Practical Stem Cell Conference

The International Cellular Medicine Society (ICMS) will host it’s first annual conference in Las Vegas on 11/5/09.  What separates this conference from every other conference on stem cells is that this one will feature physicians who use cellular therapies everyday as part of their medical practices.  In the past, conferences have focused more on theoretical concerns.  Lectures will include: basic stem cell science by Henry Young, PhD-a scientist with 35 years of experience in culturing stem cells; the use of stem cells in Orthopedics by Christopher Centeno, M.D.;  the use of stem cells to treat degenerative disc disease by John Schultz, M.D.  and  regulatory issues for stem cell use as the practice of medicine by Christine Humphrey. Agenda can be reviewed here

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Diet: Its Impact on Stem Cell Growth

Despite their terrible taste, disgusting odor and foul texture I followed by mother’s instructions: EAT your brussel sprouts.

Mom insisted that diet was essential for our growth.

Does diet have an impact on stem cell growth and differentiation? (what type of cells they will become when they grow up)

Vanella demonstrated that high blood sugar levels, those commonly seen in patients who eat sugar based diets, lead mesenchymal stem cells to turn into fat instead of bone.

There are many factors that can affect stem cell growth and differentiation.  Regenerative Sciences understands the importance of these variables in their evaluation and treatment of orthopedic disorders with stem cell therapy. The Regenexx procedure provides patients a non-surgical option of the treatment of non-healing fractures, lumbar disc protrusions and degenerative conditions in knee and hips.

Bye, bye sugar and hello greens…..

Elbow Pain: Missing the Picture

Patient returned today after initial evaluation for lateral elbow pain.  She has a 5 year history of elbow pain, localized along the lateral aspect, constant in duration, progressive in nature without any radiations.  Pain was throbbing in character and aggravated by external rotation and her daily work responsibilities.  Therapies to date had included physical therapy, massage, chiropractic care, x-rays of elbow, evaluation by sports medicine physician, trial of anti-inflammatory medications and muscle relaxants. 

Physical examination demonstrated point tenderness along the lateral epicondyle and multiple trigger points in the extensor muscles.  Neurologic exam was normal.   Cervical spine had mild reduction in range of motion which was painful.  Specifically she had pain with extension and lateral rotation.

Given her poor response to conservative therapy, persistence of symptoms and neck pain and restriction motion, I was concerned that her pain was arising from a degenerate disc in her cervical spine.  That would make sense since the muscles in her arm which were painful receive their information from the C6 nerve.  If there is compression of the nerve root,  pain and muscle dysfunction can result.

Her cervical MRI demonstrated degeneration of the C5/6 disc and compression of the C6 nerve root.

A thorough examination is essential.  This is the standard at the Centeno-Schultz Clinic.  Regenerative options for this patient include prolotherapy, IMS, cervical injections with PRP and stem cell therapy.

PRP and Athletic Injuries

 Wanted to share the treatment of a local sports personality who responded well to PRP therapy.

Patient suffered an injury to the semimembranous which is one of the three muscles that comprise the hamstring.  He had significant pain in the back of this thigh which limited his ability to run.  he had point tenderness on examination with swelling and bruising.

 The semimembranosus muscle allows us to flex the knee, extend the hip and rotate our hip inwardly when the knee is flexed.

MRI demonstrated a tear in the muscle which is identified by the white arrow.

Patient underwent  a concentrated injection of his own platelets into the area of injury to stimulate repair.  This concentrate is referred to as platelet rich plasma (PRP).  Platelets are rich in growth factors which have been demonstrated to promote natural healing. After two injections the patient had 80% improvement and was able to return to playing.  PRP therapy affords patients a natural healing treatment with minimal downtime and the potential for significant results. 

PRP has been successfully used in professional athletes as witnessed by the treatments of Hines Ward  prior to the Superbowl.

PRP is just one of the regenerative therapies utilized at he Centeno-Schultz Clinic.

Joint Health and Function: Implications of Surgical Fusions

Patient returned today who has graciously allowed me to share her history.  The key is understanding what happens to cervical joints above and below the level of the fusion. The answer is OVERLOAD and acceleration of the degenerative cascade.

35 y/o female who underwent fusion of her cervical spine at multiple levels and unfortunately suffers from severe neck and headache pain.

The disc and cervical joints serve as shock absorbers.  Take out the shock absorber surgically and the forces of daily living was transmitted above and below the level of the fusion.  The abnormal force  overload of the joint which accelerates the degenerative process.  The end result all too often is pain.

At the Centeno-Schultz Clinic, we injected a small amount of contrast into the joints above her fusion.  This is illustrated below.  Thereafter we injected local anesthetic which significantly reduced her neck and headache pain.  Patient subsequently underwent prolotherapy which has afforded her a signficant reduction in her pain and increase in her range of motion.  Other regenerative therapy options include PRP and stem cell therapy.

Joint Stability: Essential for Success

Stability of a given joint is essential for the optimal function and maintenance of the joint.

Stability is determined by many factors which include the integrity of the ligaments.

Ligaments are thick connective tissue that connects bone to bone.   An example is the deltoid ligments in the ankle.

 

 Injury to ligaments due to either to acute or repeat trauma can compromise the  integrity and support provided by the ligament.  The consequences can include degenerative changes in the joint and pain.  This was clearly illustrated in a previous blog.

In the treatment of degenerative changes in a joint, it is essential that stability of the joint is evaluated and optimized.  It is not enough to use regenerative therapies on the joint such as PRP, prolotherapy or stem cell therapy.  For maximal clinical results, the joint and its stability must be addressed and optimized.  This is the standard of care at the Centeno-Schultz Clinic and Regenexx.

Epidural Steroids Injections and Strokes

Epidural steroid injection are commonly used to treat lumbar degenerative disc disease, lumbar disc protrusions and herniations.

The epidural space contains fat, blood vessels and lymphatics.

 

Steroid injections into the epidural space can inadvertently reach the blood vessels.

The significant is twofold.  First the patient is unlikely to get clinical relief of their pain since the injection went into the blood vessels instead of  the intended target:  the nerve root and disc.

The second is more concerning. Injection of steroids into the artery can result in stroke and death.  Dawley recently demonstrated the  arterial injection of steroids lead to cerebral hemorrhage by obstructing the microvasculture as well as the toxicity of the steroid.

I have previously blogged on the mounting concerns over steroid injections.

Alternative  therapies for spine and joint pain include PRP, activated PRP, prolotherapy and autologous stem cell therapy.

PRP Therapy for Lumbar Disc Protrusion

The  lumbar disc is composed of two principal parts: the inner jelly(nucleus pulposis) and the outer side wall(annulus).  The annulus provides support similar to that of the side wall of your tire.  If the side wall (annulus) becomes weakened, it can bow out.  When this occurs it is referred to as a disc protrusion, herniation or extrusion depending upon how far it protrudes  outwardly.  The protruding disc can be painful itself or it can press upon a nerve root causing leg pain.

Steroid injections have been use for lumbar disc protrusions however there is concern over the side-effects of high dose steroids as  previously discussed.

PRP injections are rich in platelet derived growth factors which have the potential of  increasing blood flow and therefore healing of the disc.

 The Centeno-Schultz utilizes various types of PRP to treat lumbar disc disease.   Examples  include platelet poor plasma, plasma lysate and activated PRP.  Patient specific platelet rich plasma injections created in a state of the art lab as opposed to those created by portable centrifuge units   are just another example of how theCenteno-Schultz Clinic distinguishes itself.

Steroids: Patients Beware

Steroids are commonly used to treat pain.  Common examples include cortisone injections into knees, elbows, hips and lumbar spine.

There is increasing concern by many authors about the side-effects of steroid injections.

Hossain demonstrated that steroids were capable of shutting down normal repair and maintenance functions in the joint.(Apoptosis) 

Nakazawa demonstrated that steroids can turn off the production of catilage.

Wong identified a correlation between steroid use and bone death. (avascular necrosis of the femoral head)

At the Centeno-Schultz Clinic we too are concerned and have changed our treatment protocols from large dose steroid injections to low dose.  Most steroid injections use 6 milligrams of steroid.  At Centeno-Schultz Clinic we use a very dilute concentration of steroid which is compounded for our clinic.  A nanogram is 1/1000 th of a milligram.  Steroid injections at Centeno-Schultz Clinic  are between 50 to 100 nanograms.  This dilute solution has positive effects on joint health by increasing the concentration of growth factors and stimulating stem cell production of cartilage.

Other options for the treatment of pain include prolotherapy, PRP and stem cell therapy.

X-Ray Guided Prolotherapy

Prolotherapy is the injection of a proliferative agent which triggers a natural healing response. 

It has been successful in the treatment of many disorders including neck, shoulder, knee and ankle pain.  Dr. Centeno recently published an article in The Journal of Prolotherapy in which he discusses the use of x-ray guidance with prolotherapy.  This ensures that the injection is in the correct place to maximize clinical results.  Dr. Centeno discusses the use of prolotherapy for  the treatment of neck, knee, sacroillac joint, ankle, ischial tuberosity and shoulder pain.  At the Centeno-Schultz Clinic x-ray guided prolotherapy is just one of the  therapies utilized in the successful treatment of pain.

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