Stemcelldoc's Weblog

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.
 
 
 
 
 
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July 13, 2011

Lumbar Fusion: Adjacent Level Degeneration

Lumbar fusion is surgical procedure whereby the interverbral discs are fused in an effort to relieve pain.  The lumbar discs function as a shock absorber to absorb the forces of daily activity.

Do lumbar fusions impact the way in which our bodies manage the forces and stresses of daily activity?    Do they alter the body’s biomechanics?

Yes!

In a previous blog I have discussed the increased forces placed on the SI joint after lumbar fusion.  Clinically this often results in SI joint dysfunction and buttock and leg pain.

Are the discs above and below the fusion segment at risk for degeneration?

Ghiselli demonstrated the rate of symptomatic degeneration at an adjacent segment was 16.5% at five years and 36.1 at ten years.  The study involved 215 patients who had undergone lumbar fusion.  The average duration of followup was 6.7 years.

Bottom Line:  Lumbar fusion places you at risk for future surgeries.  Ghiselli demonstrated that at 10 years over 1/3 of  patients who underwent lumbar fusion had subsequent lumbar decompression or fusion at ten years.

BG is a case in point.  He is a 57 y/o patient who underwent L5/S1 fusion in 1992.  In 2005 the fusion was extended to L3/4 and L4/5 due to pain.  In 2008 a third fusion performed which involved the L2/3.   This month he presented to clinic with severe back and groin pain with an MRI significant for advanced degeneration at the L1/2 disc level with disc herniation.  He is tentatively scheduled for his fourth fusion.

The Centeno-Schultz Clinic offers non surgical alternatives for the treatment of lumbar degnerative disc and leg pain.

 

 

 

July 1, 2011

Spinal Fusion: Confidence Lost

Clincial studies are untaken to determine patient safety and efficiency of a given device.  Studies published in peer-reviewed journals are considered to be free of biasis and conflict of interest.  Such studies can led to the advancement of medicine.

Unfortunately when money is involved the rules may be overlooked or softened. 

 Medpage Today reports that doctors who received millions of dollars from Medtronic systematically failed to reveal serious complications linked to the company’s lucrative back surgery product: Infuse.  Editors of the Spine Journal found systematic failure to report serious complications and found complication rates that were 10-59 times greater than the estimated complications rates revealed in the medical literature.  The 13 papers reviewed in the Spine Journal were co-authored by doctors who received a median of  $12 million to $16 million per study from Medtronic.

Dr. Centeno has previously blogged about Medtronic’s Infuse product and the high rates of male sterility.

The Centeno-Schultz Clinic has extensive experience and expertise in the treatment of lumbar disc disease. Traditional epidural steroid injections have significant side effectsRegenexx PL is an alternative to traditional epidurals and offers a different approach in the treatment lumbar degenerative disc disease. 

Testimonials  and MRI pre and post comparisons have been previously discussed.

March 16, 2009

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.lumbar-disco

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

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

Axial Images Pre and Post Stem Cell Therapy

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