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 !

 

 

 

 

 

November 3, 2013

Iliolumbar Ligament: A Key Stabilizer of the lumbar spine

At the Centeno-Schultz Clinic stability is a central theme acknowledging that instability can lead to additional wear and tear, degeneration and injury.  To understand the importance of stability refer to  our e-book, Orthopedics 2.0

Stability is dependent upon 2 principal factors:  muscle strength and ligament integrity.

The iliolumbar ligament (ILL)I s an important stabilizer of the lumbar spine.  Ligaments are fibrous tissue that connect one or more bones together.  Think of them as duct tape.   The ILL originates from the lateral aspect of the transverse process of L4 and L5 and attaches to the anterior surface of the ilium (waist bone).  The ligament literally prevents the L5 vertebra from slipping forward.

iliolumbar ligament

Pool-Goudzwaard also demonstrated that it ILL was an important stabilizer of the SI joint.

The iliolumbar ligament can be injected under x-ray guidance or MSK ultrasound which is the standard of care at the Centeno-Schultz Clinic.  Below is an x-ray image from clinic with the ILL outlined.

The Regenexx-DDD procedure deals with both the lax ligaments and the irritated nerves without using harmful steroids.  The procedure involves platelet growth factors that are injected into the epidural space as well as into the lax ligaments.  Previous blogs have discussed clinical cases where patients have utilized their own platelet growth factors and avoided lumbar surgery.

iliolumbar ligament x-ray

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 !!

October 13, 2013

Low Back Pain: Fusion vs Non operative Treatment

lumbar fusion

At the Centeno-Schultz Clinic we acknowledge and know first hand the pain, restriction in range of motion and erosion of well-being associated with low back pain.

Previous blogs have discussed the clinical success of Regenexx PL in patients with lumbar disc disease and pain.

Regenexx C when injected directly into the disc has been demonstrated to reduce pain, increase level of activity and has been associated with changes on MRI.

Surgery in the form of lumbar fusion is the often held out by many as the answer.

Is it an effective therapy for low back pain?

No not according to Smith et al who examined this question.  In a retrospective analysis they reviewed consecutive patients with back pain and concordant lumbar discogram who were offered fusion.   96 patients were examined: 53 who underwent fusion  and 43  opted for non surgical  treatment.  Conclusion:  no improvement in pain, health status, satisfaction, or disability was noted in patients who underwent lumbar fusion in comparison to those who had conservative care.

Take away is that lumbar fusion is not the holy grail for low back pain.  Exhaust all treatments and make sure that all possible pain generators are considered.  These include myofascial,  facet, SI joint, ligamental instability, nerve entrapment and intervertebral disc.

October 1, 2013

Rear End MVA: Head Position and Neck Injury

Rear end MVA

At the Centeno-Schultz Clinic we acknowledge the potential impact of motor vehicle accidents on a patient’s well-being.

Injuries to ligaments, facet joints, muscles, intervertebraldisc and nerves can occur.acceleration deceleration

Rear end motor vehicle accidents can cause an acceleration deceleration injury to the cervical spine.

Does head position at time of impact in a rear end MVA matter?  Does it led to injury of specific areas?

Panjabi examined these concerns in a 2006 study.  He concluded that head-turned rear impact caused significantly greater injury at C0-C1 and C5-C6 facet joint, as compared to head-forward rear and frontal impacts which resulted in multiplanar injuries at C5-C6 and C7-T1.

This is significant as the pain referral patterns are different as previously discussed.

The C0-C1 facet refers to the suboccipital area whereas the C5/6 and C7/1 facets refer to the periscapular area.

c0-c1-joint-referral-pain

Periscapular referral pattern of C5/6 and C6/7 facet joint.

Periscapular referral pattern of C5/6 and C6/7 facet joint.

Knowing the importance of head position in a rear end MVA is critical to understanding what areas are at greatest risk for injury and how best to treat them.  This is standard of care at the Centeno-Schultz Clinic.

August 16, 2013

Epidural Platelet Injections: A safe alternative to steroids

At the Centeno-Schultz Clinic safety is paramount.

Platelet therapies are a safe and effective alternative to steroid epidural injections.

Platelet lysate (PL) and concentrated stem cell plasma (cSCP) are the two platelet treatments.

The efficacy of PL epidural injections compared to tradition steroid injections have been previously discussed.

We are concerned about the contamination of compounded steroid products and its sequelae.

Earlier this year the New England Compounding Pharmacy recalled compounded steroids due to fungal contamination. .   As of March 10, 2013, 48 people had died and 720 were being treated for persistent fungal infections.

 

NASS spine safety alert

This week another safety alert was issued by North American Spine Society and the FDA over concerns of bacterial infections.

Bacterial and fungal infection are serious issues with potentially serious and longterm complications.

If you suffer from ongoing neck or lower back pain consider platelet epidural injections at the Centeno-Schultz Clinic as a safe alternative to steroids.

August 13, 2013

Cervial Epidural Injections: Insist Upon X-ray guidance

At the Centeno-Schultz Clinic patient safety is paramount.

Cervical epidural injections are utilized to diagnose and treat neck and arm pain arising from the cervical spine.

Not all cervical epidural injections are performed in the similar fashion.

Some use x-ray guidance (fluoroscopy with injection of contrast) and others perform the injection without x-ray (blind).

Is there a difference?

Yes

c-arm_fluoroscopy

X-ray is used to guide and confirm the accurate placement of the needle into the epidural space.

Complications associated with not using x-ray:

Spinal nerve injury

Spinal hematoma

Injection into the spinal fluid with onset of hypotension and respiratory arrest.

Spinal cord injury.

Postdural headaches.

Vasovagal reaction.

X-ray also enables the injection of contrast (dye) to demonstrate the location and flow of medication injected.  If flow is limited to the right and the patient has pain only on the left the injection most likely will fail.  X-ray guidance documents the flow of contrast to maximize clinical results.  All cervical injections at the Centeno-Schultz Clinic utilize x-ray guidance.

Cervical-Interlaminar-Epidural-Steroid-Injection-post-contrast

Cervical epiduralw are useful in the treatment of neck and arm pain but require the use of intermittent x-ray (fluoroscopy) to minimize the significant potential complications and maximize clinical outcome.  This is the standard of care at the Centeno-Schultz Clinic.

June 6, 2013

Successful Treatment of Sciatica: Disc Herniation Location and Clinical Success

At the Centeno-Schultz Clinic knowing which patients will benefit from which procedure is key.

Sciatica due to a lumbar disc herniation can respond favorably to epidural steroid injections. The location of the disc herniation can dictate success.  Previous blogs have discussed the  successful treatment of sciatica with platelet epidural injections (Regenexx PL-M).  Pre and post MRI studies have demonstrated reduction in disc herniation which corresponded with clinical symptoms.

At recent study confirmed what we have known clinically for years.  Lee et al demonstrated that patients with herniated lumbar discs in the foraminal or extra-foraminal zone had excellent clinical response to transforaminal epidural injections.

Basic Definitions

Foramen:  Opening

Neural Foramen:  Boney doorway through which of the spinal nerve root, dorsal root ganglion, the spinal artery pass.

neural  foramen

Foraminal zone:  The zone between planes passing through the medial and lateral edges of the pedicles.

The spinal canal can be divided into three zones:  central, foraminal and extra-foraminal.

Spinal Canal Zones

Spinal Canal Zones

There are two principle types of epidural injections:  transforaminal and interlaminar.  The former is directed towards the neural foramen and exiting nerve root whereas the latter is injected into the posterior epidural space.  Successful treatment is knowing the location of the disc hernation and providing the appropriate epidural injection.  This is the standard of care at the Centeno-Schultz Clinic.

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

March 25, 2013

Regenexx Reviews: Successful Knee Stem Cell treatment for X-country Skier

Knee stem cell treatment is an alternative to traditional knee replacement surgery. The surgical complications associated with traditional knee surgery include:
A 25-31x increase in the risk of heart attack.
Blood clots in the legs or lungs or both
Infection
Wear particles.

HA is an active 62 y/o female who declined bilateral knee replacement as she was concerned about her ability to x-country ski.  She underwent Regenexx SD on   11.2012.  Additional therapies included IMS, ACL injection with Regenexx PL and injection of platelets into lumbar spine (Regenxx PL-Disc and Regenexx-DDD).

HA emailed me with updates which she has allowed me to share:

2.20.2013″ I’ve actually skied almost every weekend since early January, gradually increasing the length of time and level of difficulty.   My double knee stem cell procedure was on November 30, and it was my goal to be able to enjoy cross-country skiing again this winter.  I’ve had some minor swelling after a strenuous ski but no pain, and the swelling goes down by the next day”

3.24.2013  “Today’s ski was close to 3 hours of rigorous
skiing, up and down some big hills in NY’s
Adirondack mountains at the Garnet Hill cross-country ski area in North
River, NY.”

Knee stem cell treatment has enabled another patient to avoid surgery and return to their passion.

Struck, Heather March 2013

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