Regenexx Reviews…From Real Patients
In keeping with my goal of posting more individual patient reports, or, “Regenexx Reviews” to balance out the hard core data I’ve been posting from the registry, here’s another Facebook post. This one is about the excellent care delivered by Dr. Newton here at our Colorado clinic and the patient’s update on the early outcome of her procedures. This is our Facebook page if you want to add a like, in the meantime here’s what she said:
“Dr. Ben Newton and all the staff were beyond expectations. I travelled by air 2 1/2 hours to the clinic for L5 disc bulging and facet joint issues. My short term goal was to get some relief and not have to rely on any OTC or prescription …meds. My long term goal was to have my range of motion, considerable reduction in pain, and return to my fitness routine and riding my horse again. After two days at the clinic I boarded the plane home thinking at some point the numbing medication would wear off and I would slowly heal and have less discomfort. I’ve been home for 6 days since my procedure with absolutely NO PAIN whatsoever. Not even stiffness. I have worked out 4 times and my range of motion is back to what I had 3 years ago. I’m optimistic that my body has begun a fast track healing process without surgery or other conventional procedures suggested by my orthopedic doctor. I’m overjoyed and have told everyone about my experience. Thank you!!”
The upshot? As a physician, our first goal is to do no harm. Our second is to do all we can to accomplish the best possible outcome for our patients. I’m thankful Debbie was able to use the healing power of her own platelets and stem cells in the skillful hands of Dr. Newton…and avoid the risks and recovery time involved in surgery.
What do low back disc stem cells results look like 4-6 years after treatment? In 2005 we began treating our first low back discs with stem cells. We expected to see what the animal models predicted, i.e. significant changes in MRIs-basically new discs regrown from stem cells. Regrettably that didn’t happen as we soon learned that the animal models researchers were using bore little resemblance to the real patients with degenerative disc disease we were seeing in the clinic. Over the next few years we did learn how to use cultured stem cells to help patients with disc bulges pressing on nerves and who couldn’t be managed with conservative treatments. This technology relies on cultured stem cells, so it’s not available in the U.S., but instead only through third party licensees who operate in countries where this type of culture isn’t regulated as a drug. We are working with a third party company to bring this technology through the regulatory hoops in the U.S.
A few weeks ago, I spent a huge amount of time going through all of our charts for treated stem cell disc patients. Some were treated with the second generation of what we believed was best to treat low back discs and some with a later third generation protocol. In addition, none received what we now consider our fourth generation protocol to improve the targeting of the cells in the areas that we believe will respond the most favorably. In addition, while we took great care to ensure that most of these patients only had low back disc pain, low back pain can be caused by discs, nerves, facet joints, SI joints, muscles, ligaments, etc… As a result, some patients had good results with their disc pain, but still had other pain that needed to be addressed. Note that I was able to update many of these follow-ups to the 4-5 plus year mark post-procedure.
The upshot? This infographic is a good example of the Regenexx difference. It contains the kind of details that you can dig up in smaller datasets (i.e. details about each patient) and still present in a manageable form. It shows a ground breaking technique in evolution, but still amazing in that many of these patients avoided big surgeries by a simple injection of their own stem cells. In addition, it’s not hype, but a careful, deliberate, and transparent reporting of the data as it was collected. As always, click on the thumbnail above for a bigger PDF.
Yesterday in the clinic I had two patients before lunch that define the differences between our traditional existing spine treatment paradigms and what our clinic defines as Regenerative Spine Care (using platelets and stem cells to treat patients with bad discs, facet joints, or ligaments). The first patient was a late thirties father who had been in a large clinic system with low back pain. This began when his small son tackled and surprised him about a year ago. He spent an agonizing 7 months in their “Pain Clinic” in acupuncture and chiropractic and in and out of physical therapy, which did no good. He then saw an interventional spine physician who decided he needed medial branch blocks. These are injections to numb the little nerves that take pain from the low back facet joints. These joints occur two at each spine level and are about the size of your finger joint. Since this numbing injection helped a bit for a few hours, he then underwent radiofrequency ablation (RFA) of those joints. RFA is when the doctor inserts a needle whose tip gets very hot and burns away the little nerves that take pain from the joint. This didn’t work well either. He still can’t sit on his left butt and his hip flexors on the left are super tight. So now that you’ve heard the traditional approach, let’s switch gears into a regenerative mindset.
When I evaluated this gentleman, I noticed that the multifidus muscles in his back were about 50% smaller on his MRI than they should be. This is a concern, as these are important stabilizers of the back. It’s also a major concern, as RFA also ablates the little nerve that supplies these muscles, so if we reimaged his back now, one month after his failed RFA, I bet those muscles are now mostly gone. Can you say, “Really unstable back?” His MRI had a good sized disc bulge at L1-L2 that the radiologist said was likely irritating the existing left upper lumbar spinal nerve. Since this nerve supplies the hip flexors, this is why they’re chronically tight. In addition, from his reading on the Internet, he figured out himself that his Sacroiliac Joint (SI Joint) was likely involved, he was correct. So our focus will be using the Regenexx-PL-Disc procedure on his L-L2 disc to try an improve the health of the irritated nerve which should reduce the hip flexor tightness. Once his medial branch nerve grows back in about a year, hopefully we can get his multifidus muscles back on-line (that’s an “if”). If we need to treat his facet joints, we’ll do that with platelet rich plasma or stem cells and not by killing off an important low back nerve. Finally, his SI joint became unstable due to damaged ligaments when his son hit him from behind, so we’ll focus on healing those stretched SI joint ligaments as well.
The second patient before lunch illustrates just how some patients can respond to a regenerative approach and the stark differences between that and a traditional surgical approach. This is a young gentleman in his mid-twenties who was in a horrible catastrophic car crash. He came in contemplating major surgery on his neck and back, as his spinal cord at C3-C4 was extremely tight in the spinal canal due to bulging discs, a small canal, and buckling ligaments. His L4-L5 area was the same. His pain diagram looked like the one above. Now why would a perfectly healthy 20 something have stenosis (a crowded opening in the neck and back bones for the spinal cord)? The leading explanation was that instability in the spine was caused when the major ligaments that stabilize C3-C4 were damaged in the car crash. This caused his smaller ligaments in the spinal canal to grow bigger to try to stabilize his spine. All of this combined with injured discs to reduce the room for the spinal cord, leading to intermittent compression of the cord and the whole body pain he was experiencing (since all signals from his body pass through this area). So I agreed to use the healing growth factors isolated from his own blood platelets to both try to heal these damaged ligaments and to improve the function of these pinched neck nerves. These growth factors were carefully placed under exacting x-ray guidance into the area around the nerves (epidural). After two treatments he returned yesterday to determine next steps. He had full neck range of motion (he had none before), no more neck or whole body pain, no more back or leg pain, and had begun hitting the gym again (whereas before he was disabled).
The differences between traditional spine care and the regenerative or Orthopedics 2.0 approach are stark. I got into the car with my office manager for a lunch meeting and told him we do some incredible things. Just a decade ago I would have been the one offering the first guy a radiofrequency procedure on his back or walking the second guy over to the surgeons office!
This past week I’ve been hyper-focused on updating our long-term disc data and finally met my match yesterday. These are low back stem cell patients who had bulging low back discs treated with precise stem cell injections. It’s always an arduous task to pull all of this together, especially when some of the patients were treated in 2008 and 2009. Yesterday I called a woman from out of state. She was treated in 2009 by having her own specially cultured stem cells grown to larger numbers for a number of weeks and then re-injected into her low back disc using highly specialized imaging guidance. We could only inject one disc (L5-S1) and had plans at some point to inject her other L4-L5 disc. For our treatment registry and an IRB approved study, I needed a Likert number now and later an updated functional questionnaire. For those of you who don’t know, a Likert percentage of improvement is a great little number. This is what patients and doctors often use to communicate about the success (or lack thereof) of a procedure. For example, the patient might say that they feel 50% better. That little percentage improvement number encompasses so much: pain, function, and most importantly, value to the patient. It also transmits that information in a much more elegant way than say a standardized function questionnaire that might take 15 minutes to fill out.
So my question to this woman was: “On a scale from -90% worse to 100% better, how would you report your success or lack of success with the low back disc procedure?” She quickly replied that the horrible pain was 100% better, but that she still had pain from the L4-L5 disc that she needed to get treated. This was a problem for the scientist in me, as the 100% number she gave me didn’t really encompass the whole picture of her improvement, because she admitted she still had some pain. So I rephrased, ” Well if you had to look at the whole picture of your pain, what’s the number? I realize that the horrible pain is gone, but you’re telling me that you still have some pain from your disc we didn’t treat.” She replied that the pain that kept her from walking was a 100% gone, which was a very big deal for her. In addition, Dr. Schultz had hit that pain “dead on” when he injected her stem cells into that lowest disc. I thought to myself, Hmmmmm, this isn’t going to be easy. I rephrased my question a few more times, but I never could get another number and eventually our conversation drifted onto other topics. In the end I realized there was a conflict here. The scientist in me was only interested in a number that I could use to help quantify the success or lack of success of her procedure. Other numbers spit out of a functional questionnaire would follow. However, the physician in me realized that to her, she was being entirely accurate. The pain that disabled her for years died in full on that day in 2009 that Dr. Schultz injected stem cells into that part of her disc that was causing her the trouble. Almost like remembering a distant horrible memory, saying anything other than that it was completely eliminated from her consciousness 5 years ago was an insult to her experience. So what did I do? I reported it as, “100% relief of index disabling pain, patient still relays remaining pain from untreated disc that she is unable to accurately quantify”.
The upshot? My experience with this woman highlights the tug of war between scientists who love to quantify, doctors who understand that oftentimes quantification must mix with qualification in living and breathing patients, and the patients themselves who just want to get better and are generally oblivious at all of our attempts to define them by mere numbers. For patients it’s the experience that counts, and when you’ve had a painful and disabling monkey on your back for years and someone takes it away, it’s really “100% gone”. A valuable lesson that when the scientist gets thwarted by the difficult to quantify patient, that’s sometimes a good thing…
What does a patient think of meniscus tear repair with stem cells? I’d like to share an unsolicited e-mail I got last week. Jamie is a 57 yo man who injured his knee in June of 2012 while fly fishing. We first saw him that October with a 3 month history of right knee pain. His MRIs ultimately showed a tear of the posterior medial meniscus with ACL laxity and a pinched nerve in the low back. He was treated with the Regenexx-SD procedure for his meniscus and ACL and PL-Disc for his low back. Here are his comments:
I want to express my sincere thanks to Dr. Schultz and your organization. Dr. Schultz and his team did an excellent job with the Regenexx procedure on the torn meniscus and ACL on my right knee in October 2012. I could not have asked for any step along the way to be better! Before the procedure, Mark Reilly completed a functional analysis of my body. He made a number of suggestions of exercises that would be beneficial to my progress with my knee after the procedure and for my overall conditioning. I returned to see Mark after 6 months to assess my progress/improvements. I have had tremendous results from the Regenexx procedure. I feel that the exercise suggestions Mark made and his comparative follow-up analysis were very beneficial in helping me to objectively and subjectively assess my progress. I would highly recommend this follow-up analysis with Mark for anyone having the Regenexx procedure in the future.
Thank You to Your Entire Organization!
Las Vegas, Nevada
We’re glad to hear Jamie is doing better and also glad to hear that patient’s appreciate that we take a whole person approach to treating knees with stem cells!
Back pain and Platelet Rich Plasma? RS is a 19 year old female figure skater who was first seen by our clinic for chronic low back pain in November of 2012. She reported a 3 year history of low back pain that was worse with skating, which she performed at a very high level (training between Canada and Colorado Springs). She also reported numbness in her leg in the L5 and S1 nerve distributions. Like some skaters she had developed a spondylolisthesis, a problem where a fracture or congenital weakness in a stabilizing section of the vertebra allows it to slip forward. The traditional treatment is surgical stabilization with fusion, which likely would have ended her career. She decided to pursue the Regenexx-DDD procedure rather than back surgery and had injection of her own platelet growth factors around the nerves as well as into her stretched ligaments. She had a procedure in November and December of 2012. She reports significant improvement in her leg numbness and back pain and is ramping up her training to continue to compete at elite levels.
NOTE: Regenexx-DDD is a medical procedure and like all medical procedures has a success and failure rate. Not all Regenexx-DDD patients experience the same results.
Should we perform a low back or SI joint fusion on an active young woman just because we don’t know why she hurts? SR is a 15 year old cheerleader who was referred to our clinic because of severe and disabling low back pain. She went from a competitive cheerleader to being in severe pain, unable to walk without crutches and in bed most of the day. She had been off school for months. Her major medical diagnosis was a pars fracture at L5-S1. She had tried all the traditional steroid based pain management procedures like facet injections, SI joint injections, epidurals, etc… All were no help. She had also failed PT several times, chiropractic, and acupuncture. Prior to seeing us, she had seen a local alternative doctor who tried prolozone (prolotherapy plus ozone). This is the only treatment that provided a few days of temporary relief. She was finally referred to our clinic by a local chiropractor. This was a difficult case, one where I had serious doubts we could help. From reviewing her records, almost all of her physicians were very focused on the pars fracture (this is a part of the vertebra often seen injured in active kids), but when I ordered additional imaging, it was healed or not found at all on various images. However, there were some clues in her history about what may be really causing her disability. Like many flier cheerleaders, she had been dropped just before the onset of all of this, landing on her back side. When patients get this kind of trauma, it’s usually an SI joint injury (the joint between the tailbone and side of the hip). However, someone had already injected that joint with high dose steroids and this didn’t work. On the other hand, blind prolozone injections into the SI ligaments did provide some relief. Since the SI is a difficult joint to get into and few providers can accurately document that they have injected the joint accurately, I decided to re-inject the joint. Several years ago I published a paper on a better SI joint injection technique that allows us to more reliably get injections into that difficult to inject joint. After that first SI joint procedure, her whole leg immediately went numb and became weak. This made no sense, as the SI joint doesn’t connect with any spinal nerves at all. However, this also provided a second telling clue. The only way her leg could go numb as a result of this injection was if the major nerves that travel from the spinal cord to the leg (lumbosacral plexus) were being contacted by a leak or cyst in the front of the SI joint. The next injection into the SI joint that was performed was an arthrogram (an injection of radiographic contrast to outline the joint). This is above. The first thing that jumped out was a very uncommon cyst in the front of the SI joint. This made sense, in that injecting anything into the joint would make the cyst temporarily bigger and press on the nerves that supply the leg (which are shown above in blue, traveling right past the cyst). The next step? Use regenerative therapies in the SI joint to get rid of the cyst. The end result? The patient’s pain is now a 1/10 and her leg strength has returned. She’s off crutches and walking normally and has just started rehab to return to competitive cheer leading The upshot? Just placing magic stem cells or platelets into random areas that hurt, blind without any rationale, often doesn’t work. However, a sophisticated and thoughtful approach to finding the cause and applying a common sense therapy is what interventional orthopedics is all about. This also distinguishes it from surgical orthopedics, which would have led to a low back fusion to treat what was initially seen on imaging (the pars fracture). Performing a fusion in an active 16 year old would have been sub optimal to say the least, leaving her with a lifetime of overload injuries above and below the fused area. In particular, it would have almost certainly made the SI joint cyst much worse! The other approach favored by surgical orthopedics would have been an SI joint fusion, again leaving this active young girl with a lifetime of overload injuries at the levels above and below (the L5 area and the hip joint). Instead, a single well placed injection as an SI joint fusion alternative, was all she required.
NOTE: All Regenexx procedures are medical procedures and therefore have a success and failure rate. Not all Regenexx patients experience the same results.