Low back pain: Lumbar Facets

Low back pain can erode the quality of one’s life, spiritual and physical wellbeing.  At the Centeno-Schultz Clinic we acknowledge that there many sources of low back pain which include muscle dysfunction, ligament laxity, lumbar degenerative disc disease (DDD) and lumbar facet injury.

The facet joint is located in the posterior aspect of the spine.  It is lined with cartilage and allows for smooth non painful motion of the back.  Injury to the joint and cartilage results in pain. 

 Treatment options start with an accurate diagnosis. At the Centeno-Schultz clinic we perform both diagnostic injections to confirm the diagnosis of lumbar facet injury and well as definite therapy in the form of radiofrequency.

FZ is 55y/o athletic patient with  25 year history of low back pain which was constant in duration, 6/10 in severity, progressive in nature without radiations.  He had undergone conservative therapy in the form of PT, message, chiropractic care and trial of NSAID and muscle relaxants.  Physical examination was significant for back pain on extension and lateral rotation. 

Patient underwent x-ray guided injection of local anesthetic into the joint(intra-articular joint injection) which completely eliminated his pain for several days.  He subsequently had the nerves which provide sensation to the lumbar facet joint burned (radiofrequency).  Below are the x-ray pictures of the radiofrequency needles.  Thermal energy is conducted to the end of the needle which cauterised the targeted nerve thereby stopping the pain signal arising the joint from traveling to the brain.

FZ returned to clinic today and reports 80% improvement in his low back pain which has enabled him to get back on the ice and follow his passion.

Buttock Pain: Sacroillac Joint and Associated Ligaments

Buttock pain can be disabling and may arise from many different sources.  Lumbar degenerative disc disease, lumbar facet dysfunction, lumbar disc herniation, piriformis syndrome, inflammation of the buttock and hip tendons can all lead to buttock pain.  Diagnostic ultrasound examinations at the Centeno-Schultz Clinic can demonstrate muscle tears as well as inflammation of the tendons.

The sacrolillac joint ( SI) and its supporting ligaments can be associated with debilitating buttock pain. 

 Clinical presentation varies as illustrated in pain diagram below. 

 Patients may have pain in the buttock, posterior thigh, lower back, groin, hip and calf.

NB is  34y/o patient with 5 year history of  buttock and groin pain which was progressive in nature and constant in duration and prevented her from walking, running or playing with her children.  Therapies to date had included exploratory surgery, consults with GYN, urologist and neurologist, PT and oral medications.

At the Centeno-Schultz clinic patient underwent prolotherapy of the SI joint and the supporting ligaments.  Successful outcome is dependent x-ray guided placement of proliferate solution into the joint as well as the supporting ligaments.  A recent article underscored the importance of the treating the iliolumbar ligament as it is essential to the stability of the SI joint.  This the quality of care one can expect at Centeno-Schultz Clinic.  Stem cells utilizing the Regenexx procedure have also provided patients with SI joint pain significant relief.

NB returned to clinic recently and reported 80% improvement in her symptoms.

Another Success: Treatment of Supraspinatus Tear with Stem Cells

In a previous blog I discussed the clinical success of rotator cuff repair using expanded stem cell therapy.

Today we had the opportunity to review MRI images of an elderly patient who also underwent the Regenexx procedure 2 years ago for a supraspinatus tear.  AB  is an 80 y/o patient with neck, headache and shouder pain.  Her shoulder pain was severe and  she was unable to lift her shoulder.  She declined surgery and elected to proceed with mesenchymal stem cell therapy.  Her own stem cells were injected into the rotator cuff tear under x-ray guidance. 

To understand the differences in pre and post  MRI’s, some basic MRI concepts and anatomy is essential. 

The image above is the patient’s pre-injection coronal MRI.  The rotator cuff tendon is the area of interest.  The rotator cuff is compromised of 4 principle muscles.  Muscles have two parts:  the muscle belly and the attachment of the muscle to bone(tendon).  Tears in the rotator cuff commonly involve the tendon.

Above are AB’s pre and post MRI’s .  On the left the rotator cuff tendon(red arrows) are bright in color and mottled in appearance.  This means that it’s a full thickness tear with severe degeneration.  On the right is AB’s MRI 2 year post stem cell injection.  The rotator cuff tendon identified by the yellow arrows is better organized and darker in color consistent with significant healing.    This is consistent with her clinical improvement.  She reports 100% improvement in pain and  full range of motion.

Repair of Rotator Cuff Tear with Stem Cells

The rotator cuff is compromised of 4 principles muscles and their tendons:  supraspinatus, infraspinatus, subscapularis and teres minor.  Collectively they stabilize the joint and allow for movement .  Tendons at the end of the rotator cuff muscles can become torn resulting in pain and restriction in motion.  The majority of tears occur in the supraspinatus tendon. Typical presentation includes pain with impaired motion. Surgical treatment often involves arthorscopic repair, subacromial decompression or use of an anchor to secure the tendon to the bone.  Surgical complications included fatty atrophy, re-tears of the rotator cuff,  infection and failure.

 JG is a 32y/o patient at the Centeno-Schultz Clinic who suffered shoulder injury after a motor vehicle accident.   Despite surgery in the form of subacromial decompression  JG continued to have shoulder pain.  Repeat MRI demonstrated near complete rotator cuff tear involving the supraspinatus.  He declined surgery and opted to undergo the Regenexx procedure whereby he could use his own mesenchymal stem cells. 

2 years after stem cell therapy JG reports greater than 90 % reduction in pain and full range of motion. Post stem cell injection MRI is posted below.  The supraspinatus tendon is outlined with red circle.  On the left there is a significant tear whereas on the right the tear is significantly improved.  This corresponds with JG’s clinical improvement.  Other patients have also undergone successful stem cell therapy for rotator tendon tears.

PRP Therapy: Critical Differences

Platelet rich plasma (PRP) therapy has gained increasing attention as a non surgical option for musculoskeletal injuries. Platelets are rich in growth factors which mobilize repair cells, promote cell division and accelerate healing.  At the Centeno-Schultz Clinic  PRP has been successful in treatment of elbow, hip, knee and heel  pain( lateral and medial epicondylitis, piriformis syndrome, patellar tendinopathy and Achilles tendinopathy.

 Maximal clinical results  are obtained when  an accurate diagnosis is established, injection of PRP is performed under ultrasound guidance and a labatory prepated PRP is utilized.

 Identifying the source of pain is essential.  Delivery of the platelet concentrate must be directly into the area of damage.  Ultrasound gives direct visualization of the damaged tissue and the where the injected platelets are going.  At the Centeno-Schultz Clinic we have a state of the art laboratory which enables us to prepare a customized platelet concentrate which has a higher number of platelets and less cellular debris than bedside centrifuge units commonly employed by most clinics.