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.

Let It Grow: The Role of VEGF

 

 

Everyone knows that a seed will not grow without sufficient nutrients and water.

So to with stem cells when implanted in an area that is low or deficient in nutrients.  Blood flow is the key to cellular growth.  No blood flow, no growth.

Lumbar discs have poor blood supply.  One of the growth factors derived from platelets has been utilized to enhance blood flow to lumbar disc and the stem cells which have been implanted in them.  The growth factor is VEGF :Vascular Endothelial Growth Factor.  It has the capacity to create new blood vessels (angiogensis) thereby enhancing nutrient flow.

A case series of patients who underwent implantation of autologous mesenchymal stem cells into the symptomic disc had injections of concentrated VEGF.  66% of patients had a significant reduction in pain.  The before and after stem cell therapy MRI’s clearly demonstrate a reduction in the size of the disc protrusions.

Regenexx.Regeness.MSC.

Lumbar Discography

Lumbar Discography is a pre-surgical procedure to identify whether one of more of the lumbar discs is a “pain generator’.  It is a procedure that should only be undertaken if all other possible sources of pain have been excluded and the patient is prepared to undergone surgery.  Other sources of lower back pain include lumbar facets, sacroiliac joint dysfunction, ligamental instability and trunal dystonia.  At the Centeno-Schultz Clinic we are committed to evaluating all possible sources of pain prior to proceeding with discography.

Lumbar discography involves placing a needle under sterile conditions into the center of the disc at two or more levels.  For example, one would place one needle at the L5/S1 level and another at the L4/5 level.  Once the needles have been successfully placed, a small but increasing amount of pressure is applied to a single disc by injecting contrast through a hand held manometer.  The patient is awake and asked a series of questions which include whether or not the increasing pressure recreates his or her daily pain.

A surgeon will use this information to plan the appropriate surgery.   A lumbar fusion is most common, involving one or more levels where the supporting muscles are resected from the bone and the lumbar disc is removed and replaced with bone.  Screws and rods are often utilized to stabilize the fusion.

Lumbar Fusion with Hardware

An alternative is to use bone marrow-dervied stem cells to regenerata the disc.  Regenexx is a simple needle-in, needle-out procedure which allows the patient to forgo the risks of surgery, anesthesia and the extensive and painful rehabilitative period. Regnexx enables a patient to use their own stem cells thereby eliminating the risk of disease transmission and rejection.

Please review the MRI below of a patient who had undergone lumbar surgery without reduction in their pain. The L5/S1 disc is outlined by the dashed circle.  The picture on the left is pre-procedure whereas the image on the right is 13 months after injection of patient’s own stem cells.  Note that the disc has gone from dark (dehydrated) to bright(holding onto the fluid).  The more the disc is able to hold onto water, the better the disc is able to absorb the forces of daily activity. Finally the red arrow on the left,  points to a disc bulge which contacted the traversing nerve root.  13 months after therapy, as seen on the image on the right, the bulge and nerve root irritation is gone.

Axial Images Pre and Post Stem Cell Therapy