Stemcelldoc's Weblog

April 27, 2014

Successful Platelet Epidural Treatment for Severe Leg Pain

Helicopter skiing in Canada.

helicopter skiing canada

Skiing the trees in Aspen.

Surfing in California.

california-surfer

 

These are activities that BC enjoyed after undergoing specialized platelet epidural injection at the Centeno-Schultz Clinic.

Regenexx PL-Disc utilizes a supercharged collection of platelet growth factors that are injected under x-ray around the irritated nerve roots and lumbar disc.

Regenexx PL-Disc is differs from traditional platelet rich plasma (PRP) as it created by a cell biologist, has reduced white and red cell contamination and higher concentration of platelet growth factors.

High steroid epidural steroid injections have significant side-effects and platelet injections are a viable alternative as discussed in video below.

 

CB is  39 y/o outdoor enthusiast who presented to the Centeno-Schultz Clinic with a 20 year history of right leg pain that was progressive in nature originating in the buttock extending down to the lateral aspect of the foot.   Aggravating factors included coughing, sneezing and prolonged sitting.   Treatment to date had been extensive and included heat, ice, physical therapy, massage, chiropractic care and high dose epidural steroid injections.  Patient had undergone a L4/5 laminectomy and decompression due to disc herniation in 1991.

MRI was significant for facet hypertrophy and right-sided disc bulge at L4/5 with impingement of the L4 nerve root.

CB underwent two x-ray guided injections of the right L3-S1 facets and the right L4 and L5 nerve roots and epidural space with Regenexx PL-M over 2 months.

These treatments allowed him to engage in a 14 day 3 state epic trip.

I saw CB in clinic post trip and he continued to feel great with no leg pain or restrictions.

Congratulations !

 

 

 

 

 

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October 16, 2013

Regenexx Patient Completes 2013 Kona Ironman

Image your day consisting of a 2.4-mile (3.86 km) swim, a 112-mile (180.25 km) bicycle ride and a marathon 26.2-mile (42.2 km) run.  This is without breaks and all events must be completed in 17 hours.

To participate you must have completed prior Ironman competitions under certain and strict guidelines.

kona ironman

Welcome to the Kona Ironman, which is the world championship of all Ironman.

TG is a patient who presented to Centeno-Schultz Clinic with the aim of successfully completing Kona despite ongoing knee pain.

TG is 54 y/o avid athlete and professional with a 15 month history of right knee pain localized on the medial aspect without radiations and  associated with  limp and intermittent swelling.  Treatment to date included unloader brace, steroid injection, PT, massage, trial of NSAID and two knee arthroscopies with partial resection of the medial meniscus.  MRI was significant for mild scarring of the ACL, tear of the medial meniscus, partially extruded medial meniscus , edema in bone on medial femoral condyle and thinning of cartilage in medial and patella femoral compartment and laxity of MCL.

Physical examination was significant for asymmetric calf girth, quadriceps weakness, decreased sensation in right big toes, laxity of the ACL and MCL( medial collateral ligament) and right knee swelling.

Lumbar spine x-ray demonstrated disc space narrowing and 3 mm anterolisthesis.(slippage)

What! Why the back? Refer to SANS in free Ortho 2.0 text

Treatment included:

x-ray guided prolotherapy of ACL and MCL.

Regenexx cSCP into the lumbar epidural space at L4/5 and L5/S1.  Regenexx PL-Disc

Prolotherapy of the supraspinous,  intraspinous, and iliolumbar ligaments.

Regenexx cSCP injected into ACL, MCL.

One of TG’s largest concerns prior to the competition was his knee and he reports that he ‘had no problems”.

We acknowledge all the time, hard work, commitment and dedication it took to qualify and complete in the Kona 2013 Ironman.  Thank you for allowing Regenexx to assist you in achieving your goal.

CONGRATULATIONS !!

May 21, 2013

Successful Platelet Lystate Injection for Lumbar Disc Extrusion

At the Centeno-Schultz Clinic we acknowledge the disability, frustration and pain associated with lumbar disc degeneration.  We offer Regenexx PL-M where platelet growth factors are injected into the spine in an effort to increase healing and decrease pain.  This is an alternative to the traditional steroid injections which have been associated with signficant risks.

OM is our most recent success story.

OM is a 29y/o active male s/p microdiscectomy who presented with a 1.5 year history of lower back pain, constant in duration, non progressive in nature, localized in lumbar spine with radiations down the right leg extending into the toes.  The pain was sharp, stabbing and aching in character.  Treatment to date included chiropractic care, NSAIDs, oral narcotics, muscle relaxants and surgery in the form of microdiscectomy.  MRI was signficant for degenerative disc disease at both L4/5 and L5/S1 with large extruded disc at L4/5 causing nerve root irritation and severe narrowing fo the central canal.

OM underwent 3 x-ray guided lumbar epidural injections with Regenexx PL-M along with prolotherapy of the supporting ligaments.  On followup he reports signficant improvement in both his lower back and right leg pain.  He has resumed his regular activities, has no restrictions and is no longer on oral medications.

Below are pre and after MRI images which demonstrate a signficant improvement in the disc extrusion.   Note the reduction in the size of the disc protrusion which is noted in the formal MRI report.

Lumbar DD RX MRI reportLumbar DD RX MRI report 1Lumbar DD RX PL-M 2012.sag

January 3, 2013

Platelet Lumbar Epidural Gets Hiker Back onto Trails

hiker

At the Centeno-Schultz Clinic we acknowledge that low back and leg pain secondary to disc degeneration can be disability and severely restrict  one’s activity.

Regenexx PL has been used successfully in the treatment of back and leg pain.

PL denotes platelet lysate which is a process conducted at our state of the art lab.   The growth factors within the platelets are released from the cell membrane making them immediately available for healing.

Below is a recent clinical success utilizing platelet growth factors.

SF is 58 y/o hiker who presented to the Centeno-Schultz Clinic with 2.5 month history of right leg discomfort and weakness. Onset of symptoms was atraumatic and occurred while hiking. Weakness was constant and SF had difficulty with lifting his foot which made hiking difficult.

Initial treatment included oral steroids x 2 despite the side effects associated with steroids.

MRI of lumbar spine was signficant for broad-based right disc protrusion which displaced and flattened the right L5 nerve root.  This would explain his foot drop.

Slide1

SF returned to clinic today after two x-ray guided Regenexx PL-M epidural injections.  He reports 90 % improvement in discomfort and 80% improvement in right leg weakness.  He avoided surgery and is now back on the trails hiking due to the benefits of platelet growth factors.

August 5, 2012

Clinical Success Utilizing Regenexx PL-M in Patient with Severe Back and Leg Pain

At the Centeno-Schultz Clinic we acknowledge that low back and leg pain can be disabling. It can make the simplest of tasks virtually impossible.

This was the case with TA who could barely walk without assistance.  In caring for her children she had sustained an abrupt onset of severe lower back pain that traveled down her leg down to her foot.  The pain was electrical in character and aggravated by virtually movement.  MRI was signficant for lumbar disc degeneration and disc protrusion.  Physical exam was significant for musculoskeletal distress, weakness and numbness in the big toe and lateral aspect of foot and severe pain with straight leg raise.

As opposed to  an epidural injection with high doses of steroids, TA underwent x-ray guided  epidural injection with Regenexx PL-M which contains platelet derived growth factors intended to decrease the inflammation and increase the blood flow to the injured lumbar disc and inflamed nerve root.  PL-M is the newest platelet therapy at Regenexx and has demonstrated improved mesenchymal stem cell growth when compared to commonly used bed side centrifuge PRP concentrates.

TA  e-mailed me yesterday detailing her clinical success.  Graciously she has allowed me to share her comments.

“Hey there, Doc. I just wanted to thank you!!! my back is at least 80% better!!! once again life changing!!! I am once again able to be active. I don’t know what happened where my pain came back, but I can always count on you to fix me!!! thank you!!! you are my hero!!! : ) keep up the good work!!! “

December 26, 2011

Low Back Pain: Think Lumbar Facet

At the Centeno-Schultz Clinic we are committed to identifying the source of a given patient’s pain.  Back pain can arise from many sources which include dysfunctional muscles, structural instability, facet joint, sacroiliac joint and  disc degeneration.  Ortho 2.0 details the importance of function and stability.

The lumbar facet joint is a small joint in the posterior portion of the spine that is composed of the superior articular process of one vertebrae and the inferior articular process of vertebrae directly below it.  Similar to the knee-joint,  the facet joint is lined with cartilage which allows for  smooth and  painless motion.  It functions to limit the movement of each spinal  motion segment.  Trauma, instability and degeneration can cause damage to the cartilage lined joint resulting in pain.  Conventional radio-graphic studies often times fail to demonstrate facet injury.  Diagnosis is made by injection of local anesthetic into the joint (intra-articular facet injections) or medial branch blocks.

AB is 36 y/o patient with 10year history of low back pain, constant in duration, progressive in nature over the last 11 months, localized in lumbar region right>left with radiations into hips.  Pain was sharp and throbbing.  Aggravating factors included prolonged walking, sitting and running.

Alleviating factors:  percoset, ice and rest.

Treatment to date included PT, chiropractic care, oral narcotics and muscles relaxants.  Patient had undergone two  lumber epidural steroid injections without significant benefit.

MRI of lumbar spine was significant for mild disc degeneration at L4/5, L5/S1 and facet degeneration at L4/5 and L5/S1.

Patient presented to Centeno-Schultz Clinic frustrated with the treatment to date and lack of  improvement.  She underwent x-ray guided injection into the lumbar facet joints which has provided her significant and sustained benefit.

Rather than relying exclusively on the MRI which demonstrated degeneration of the lumbar discs we took history and performed a thorough physical examination which was significant for lumbar facet dysfunction.

Comprehensive care is our commitment at the Centeno-Schultz Clinic.  In order to save a joint not only do you need to know how to help that joint, but you also need to know how it got that way in the first place.

November 27, 2011

Intracranial Hypotension: Treatment with Stem Cells

 Intracranial hypotension is caused by spinal cerebrospinalfluid (CSF) leaks and is known for causing orthostatic headaches. It is most commonly seen in patients who have undergone lumbar punctures (LP’s) or inadverent dural puncture during epidural placment.

Spontaneous spinal cerebrospinal fluid leaks is also an important cause of new headaches in young and middle-aged individuals. The incidence has been estimated at 5 per 100 000 per year,with a peak around age 40 years. Women are affected more commonly than men.

Stem cell therapy in the form of Regenexx SCP  has been utilized in a patient with chronic dural leak.

Clincial improvement to date has been encouraging with an increase in function and decrease in symptoms.

Typical magnetic resonance imaging findings include:

  • subdural fluid collections
  • enhancement of the pachymeninges
  • pituitary hyperemia
  •  sagging of the brain
  • engorgement of venous structures

Myelography is the study of choice to identify the spinal CSF leak.

November 9, 2011

Lumbar Fusions: Cancer Risk ?

Bone morphogenetic proteins (BMP) are a group of growth factors that induce bone formation.   Surgeons use BMP  in spinal fusions reducing the need to use  a patient’s own bone and the complications and pain associated with bone harvesting.
 
Rate of lumbar fusion has increased 1500% from  2002 to 2007.
 
 
 The use of BMP in spine fusions increased  from 0.69% in 2002 to 24.89% in 2006.
 
Is it safe?
 
The use of BMP is associated with higher rate of complications with the primary increase seen in wound related complications.
 
A Medpage article on FDA approved  BMP used to promote fusion noted an increased  risk of cancer by 4-5X.  Patients who received BMP were four to five times more likely to develop at least one new malignancy.
 
 
Stem cell therapy is an alternative to spine surgery.  There are multiple benefits of treating bulging or herniated discs with Regenexx PLFailed back syndrome is one of many known complications associated with spinal surgery.
 
Clinical success with Regenexx PL for lumbar spine  pain have been previously highlighted.
 
 
 
 
 

September 30, 2011

Epidural Fat and Resultant Narrowing of the Lumbar Canal: A Complication of Epidrual Steroids

Epidural steroid injections are a common treatment for back and extremity pain.  Steroid injections have been associated with complications with include  changes in blood glucose and cortisol levels, infection. apotosis( programmed cellular death), damage to cartilage and the development of  avascular necrosis .   At the Centeno-Schultz Clinic platelet derived growth factors are been used  successfully in the treatment of cervical and lumbar pain.  A  patient who failed traditional epidural steroidshad signficant improvement after Regenexx PL epidural injections.

accumulation of fat around the epidural space can occur as the result of epidural steroid injections.  Narrowing the canal can cause  compression of spinal nerves with resultant pain and restriction in level of activity,

Tok reported a case where a patient developed neurologic symptoms secondary to abnormal epidural fat after a single epidural injection. Sandberg reports symptomatic compression of the neural elements from  excessive epidural fat after repeated epidural steroid injections.

 McCullen reported a similar case   after multiple steroid injections.

Fogel in at literature review and meta analysis demonstrated that exogenous steroid use, obesity and endogenous steroid excess are all associated with symptomatic epidural fat accumulation.

RW is a 45 y/o patient with chronic lower back pain who had received a larger number of lumbar epidural steroid injections from a local pain practice.  He transferred his care to the Centeno-Schultz Clinic.   RW’s lower back pain had escalated in severity.  His most recent lumbar spine MRI was significant for two level narrowing of the spinal canal in part due to a large accumulation of  epidural fat which was not present years prior.  The image below is RW’s most recent MRI.  The blue arrow identities the narrowing of the spinal canal at the L5/S1 level due to multiple steroid injections.

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