Stemcelldoc's Weblog

August 9, 2009

Results of Stem Cell Therapy Presented at National Meeting

A case series outlining the results of patients who underwent stem cell therapy for symptomic lumbar disc protrusions was recently represented at the National American Society of Interventional Pain Physicians. The abstract is #8. Patients utilized their own stem cells which were expanded and then re-injected into the painful disc. A majority of the patients had a significant reduction in their symptoms as well as changes on MRI.

Case series 2

The Regenexx procedure affords patients an alternative to the risks of surgery and anesthesia. In contrast to conventional surgery, there is no significant down time or need for extensive rehabilitation.

July 21, 2009

Origins of the Regenexx Procedure

pulling-hair-out

Continued frustration and disappointment over the persistent failure of many surgical procedure to improve the pain and level of function of our patients led to the quest for an alternative.

Sakai was our first inspiration.  He recognized that disc degeneration was a relentlessly progressive phenomenon with no currently available effective treatment.  Working with rabbits, Sakai transplanted  mesenchymal stem cells into degenerative disc  to determine if stem cells were capable of repairing degenerated discs.  While mesenchymal stem cells are available from many sources, Sakai obtained cells from bone marrow.  The Regenexx procedure also uses bone marrow derived stem cells.

At 24 weeks, utilizing MRI and another methods, Sakai demonstrated that transplantation of mesenchymal stem cellss effectively led to regeneration of degenerative discs.

And the quest began……..

May 21, 2009

Look Ma ….. No Scapel

Lumbar discs remain a major source of pain and disability.  When a disc protrudes outwardly it commonly affects one or more nerve roots with resultant leg pain.  Therapies for lumbar disc protrusions include physical therapy, traction,  anti-inflammatory agents and steroids. 

Ouchhhhh   Bulging disc compressing nerve root !

Ouchhhhh Bulging disc compressing nerve root !

If symptoms don’t improve many patients are referred to surgery.  Common surgeries include lumbar discectomies where the protruding disc is surgically trimmed.

A new therapy utilizing a patient’s own stem cells has demonstrated very exciting and promising results.  Below are the MRI’s of a patient who had debilitating lower back and leg pain despite conservative therapies.  Patient underwent the Regenexx procedure with dramatic results.

fdaregulationstemcells.

A Stransky L5-S1 Disc_Page_2

A Stransky L5-S1 Disc_Page_1

February 26, 2009

The Importance of Blood Supply

Blood supply to a given structure provides essential nutrients for growth, maintenance and repair.  Some structures such as the heart have a rich blood supply with multiple arteries.  Other structures have a very limited, tenuous blood supply which places them at risk for impaired growth, repair and potential cellular death. The lumbar intervertebral disc is such a structure.  While it is the cornerstone of our spine and bears the weight of our bodies as we walk, its blood supply is extremely limited.

What does this mean?  If injuries occur the lumbar disc has limited capability of repairing itself due to its very limited blood supply.  The result is a slow insidious degeneration of the lumbar disc characterized by reduction in disc height and signal.  The MRI  below on the left illustrates a degenerative L5/S1 disc.  The blue arrow identifies the spinal cord, the red arrow is pointing to the cerebral spinal fluid and the black arrow identifies the L3/4 disc.  Note the L3/4 disc has a white signal within the disc which represents hydration.  It also is identical in height and brightness to the disc above it.  Both of these discs are normal.  The white arrow identifies a degenerative L5/S1 disc which is black in color with reduction in height in comparison to the adjacent discs.

Degeneration of lumbar spine

Degeneration of lumbar spine

 With injury there is also a propensity to develop bulges since the integrity of the side wall (annulus fibrosis) is compromised. 

Disc Bulge

Disc Bulge

 If sufficient damage occurs, a disc bulge can progresses to a disc herniation where an portion of  the inner contents of the disc (nucleus pulposus) are extruded.

Lumbar Disc Herniation

Lumbar Disc Herniation

In a previous blog I discussed the importance of platelets and the four major growth factors they contain:   Platelet-derived growth factor (PDGF), transforming growth factor beta (TGF-b), vascular endothelial growth factor (VEGF) and epithelial growth factor (EGF). Vascular endothelial factor is responsible for angiogenesis (the creation of  new blood vessels).  These new blood vessels can provide essential nutrients to repair damaged tissue.  At Regenexx we injected concentrated VEGF adjacent a degenerative disc with the hope of improving blood flow and initiating repair.  Please see MRI results below.  On the left are MRI images of the L5/S1 disc prior to therapy.  Note there is a reduction in height and brightness of the L5/S1 disc.  On the right are MRI images of the same L5/S1 disc after therapy.  Note an increase in the height and the signal of the disc.  There is significant improvement in the disc height and signal.  What is the significance?  This is a patient who despite prior back surgery continued to have pain.  After therapy at Regenexx the patient had near complete resolution of pain as well as MRI evidence of lumbar disc repair.

Before and after therapy of L5/S1 Disc
Before and after therapy of L5/S1 Disc

stemcelltherapy.lumbardegenerativediscdisease.alternativestolumbarsurgery.CentenoSchultClinic.VEGF

January 8, 2009

Lumbar Degenerative Disc Disease and Discectomy

Lumbar degenerative  disc disease is very common.  Virtually everyone at some point in their life has lower back pain.  Fortunately for many the pain resolves never to return.  For others their back pain becomes chronic and erodes the  quality of their life.  These individuals seek the advise of professionals which  include surgeons.

Yesterday I had the opportunity to evaluate a patient who was seeking a second opinion for her severe left sided back pain.  A surgeon had recommended a discectomy.  Her MRI showed moderate degeneration of the L5/S1 disc with a slight protrusion. 

lumbar1

 

 

 

 Her examination was significant for  exquisite tenderness in her left buttock with only mild tenderness in her back.  At the Centeno Schultz Clinic we are committed to identifying the source of a given patients pain.  We accomplish this through diagnostic injections performed under intermittent x-ray.  Back pain can arise from many sources which include muscles, ligaments, facets, the sacroiliac joint as well as the disc.  Due to this patients severe tenderness over her left buttock I injectioned  her  left sacroilliac joint which to her surprise provided her with 100% pain relief.  

 

 

The sacroillac  joint is a source of lower back and buttuck pain in approximately 15% of the population.   

si-joint

 

 

 

 

 

 

 

 

This patient  did not need a discectomy but rather a thorough assessment of her back pain.  spine-surgery

 

 

 

 

 

 

 

 

 

 

 

 

alternatives to discectomy.Centeno Schultz Clinic. Lumbardegenerative disc disease.Regenexx.sacroillac joint pain.stem cell therapy.stem cell therapy for lumbar disc

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