Stemcelldoc's Weblog

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 15, 2009

Alternatives to Lumbar Discectomy

Lower back paincan arise from many sources including facets, sacroillac joints, ligamental instability, muscular dysfunction and  the lumbar disc.  Discectomy is a   common surgical procedure for lower back pain where the disc bulge is surgically trimmed.  In the short term this may be beneficial but in the long term it can result  in progression of the degenerative process by compromising the integrity and blood supply of the disc.

The disc is composed of two principle components:  the  annular fibrous and nucleus pulpopus

annulus2

The annulus is a ring of strong ligamental fibers that encircle the inner core of the disc.    The nucleus pulpopus is the inner core and is compromised of jelly like material. The annulus fibrous functions to prevent the nucleus pulposus from leaking out. It is best thought of as the sidewall of a tire. It is also the only part of the disc that has a significant blood supply. 

A discectomycuts through the sidewall of the disc thereby weakening the fibers that contain the nucleus pulpopus and compromising the blood supply to the disc.

Regenexx offers patients an alternative to surgical therapies by using their own stem cells to regenerate the damaged sidewall of the disc.  To understand the potential of stem therapy please click video.

alternatives to discectomy.discetomy.discotomy.stem cell therapy. HPN. regenexx. annulus fibrous. low back pain. facets.

January 14, 2009

Alternatives to Back Surgery

As a physician I have seen thousands of patients with lower back pain some of who go on to have back surgery.  Surgical therapies for back pain include discectomy, foraminotomy and fusion.  A discectomy is where a portion of the protruding disc is trimmed thereby relieving its compressive effect on the nerve root. 

discectomy

foraminotomy is opening the doorway (neural foramen) through which a nerve passes as it leaves the spine. Its goal is to relieve the compression on the nerve root.  neural-foramen

 

 

 A lumbar fusion removes the lumbar disc and replaces it with an artificial disc, spacer or bone along with stabilizing hardware.  The theory is that the disc is the pain “generator”.

 

fusion1

 

Unfortunately with all back surgeries patients are exposed to the risks of surgery, anesthesia and extensive rehabilitation.  Another issue that is rarely addressed is failure.  That is to say that the surgery may not relieve the pain and can in some cases  makes it worse.  Surgery is a one way door.  Once the disc is trimmed or removed there is no turning back.  One year and 4 year studies have demonstrated no difference between surgery and conservative therapy in patients with low back pain.

Patients now have an alternative to surgery utilizing stem cell therapyRegenexx enables the patient to use their own stem cells to repair damaged discs.

disc.discetomy.discectomy.lumbarfusion.stem cell therapy.foramintomy.foraminectomy.Regenexx

January 12, 2009

Lumbar Disc Bulges and Leg Pain

Lumbar disc bulges are a common cause of lower back and leg pain.  Common therapies for lumbar disc bulgesinclude physical therapy, lumbar traction, inversion table therapy and lumbar epidural steroid injections.  The goal of therapy is to decrease the disc bulge and its compressive effect on the nerve root.  If nerve compression is left untreated, it can result in permanent leg pain and weakness.

disc-bulge

Lumbar epidurals steroid injections should always be performed under x-ray to ensure accurate placement of the medication. The epidural space is the area immediately outside the spinal cord and is adjacent to the lumbar disc.

epidural-space1

 

 

 If a lumbar epidural steroidis performed without x-ray there is no guarantee that the medication will get into the epidural space let alone on the irritated nerve root and disc.  At the Centeno-Schultz Clinic all lumbar epidurals are performed under x-ray.  Injection of contrast prior to the injection medication, ensures accurate placement. The x-ray below demonstrates contrast flowing along the right L5 nerve root with extension into the epidural space.

epidural-injection-unders-x-ray

If conservative therapy or lumbar epidural steroid injections fail to provide sustained pain relief, patients now have the option of using their own stem cells to repair their lumbar disc bulges using the Regenexx procedure.  Regenexx is a simple needle in-needle out procedure which affords patients the opportunity to avoid the risks of surgery and anesthesia and repair disc bulges.

Review the video below on how stem cells can be used to treat disc bulges.

[youtube=http://www.youtube.com/watch?v=zI7TQzV

January 11, 2009

Chronic Back Pain

Chronic lower back pain can arise from many sources.  Unfortunately many patients are not provided a thorough examination and evaluation by a physician specializing in pain management.  Often times patients are reflexively placed on muscle relaxants and narcotics with no effort to identify the source of  back pain.  If the pain does not resolve some patients are offered low back surgery.  Regrettably both of these options to treat chronic back pain have the potential of making it worse.  At the Centeno-Schultz Clinic we are committed to identifying the source of  lower back pain so the correct treatment plan is selected.

For example, chronic back pain due to a disc bulge with compression on the nerve can be successfully treated with a stem cell injection into the disc. Patients now have the option of using their own stem cells to repair lumbar disc bulge at Regenexx.

Below is an MRI of the lower back.  On the left, note a disc bulge.  On the right, following a stem cell injection there is a marked reduction in the disc bulge.  The patient had 100% pain relief.

regenexx-lumbar-disc-info-patientonly-jpg

chronic back pain.alternatives to lumbar surgery.stemcell therapy for lumbar discs.regenexx. Centeno-Schultz Clinic

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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