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.
Patients are looking for answers to help guide them through what has been a tough month for epidural steroid injection reviews and side effects. To that end follows For example, in one recent study, steroid epidurals increased bone loss in post menopausal women by 600% after a single shot! Yikes! As a result, getting rid of the steroids in these shots should be top priority for patients and physicians alike. Today I’d like to share the outcome results of a patient who received the Regenexx-PL-Disc procedure, which uses the patient’s own growth factors instead of harmful steroids. OH is a 29 year old active man who had already had undergone a failed L4-L5 microdissectomy procedure and failed 2 steroid epidural injections as well as extensive conservative care. While his low back surgery did help the radiating pain into his leg, it didn’t help his back; so at the time he was seen by Dr. Schultz in June of this year, he still had 4-5/10 low back pain. In addition, he still had a large disc bulge at L4-L5 on his MRI which was compressing the exiting right L5 nerve root. He underwent the Regenexx-PL-Disc procedure in June and August of this year and now reports 80% clinical improvement. Despite the patient not being a candidate for spontaneous resolution of his disc protrusion due to the fact that he had already had one surgery and had a several year history of pain that wasn’t helped by prior injection based care, he responded to using his own growth factors. In addition, his MRI report from imaging taken after the Regenexx-PL disc procedure is above. What happened? First, there are two common terms seen on low back disc MRI reports-a disc protrusion and a disc extrusion. A protrusion means a bulge, while an extrusion means a herniated disc. In a disc bulge, the softer gel like material inside the disc places pressure on a damaged, but still intact outer disc wall, which causes it to bulge out. Oftentimes, disc bulges are static and don’t heal, in fact they mostly get worse over time. We’ve had good success getting rid of protrusions by using the Regenexx-C stem cell procedure and placing stem cells inside the disc using specialized tools. A disc extrusion is another story, as that’s when the soft gel inside the disc herniates outside the disc wall though a complete tear. Many times a disc “extrusion” will heal on it’s own, but other times it becomes a static feature. We have seen the Regenexx-PL-Disc procedure get rid of these extrusions that had moved into the static phase (not resolving on their own), likely by increasing blood flow in the area. The PL-Disc procedure places healing growth factors in the area instead of toxic steroids. One of these growth factors is VEGF. Vascular Endothelial Growth Factor can increase blood flow by building new blood vessels. We believe OH is one such patient who benefited significantly from using his own growth factors versus harmful steroids.
NOTE: The Regnenexx-PL Disc procedure is a medical procedure and like all medical procedures has a success and failure rate. Not all Regenexx-PL Disc procedure patients will ecperience an 80% improvement.
I always tell my patients that upper back surgery procedures are awful. If you happen to have a big herniated upper back disc pressing on your nerves and spinal cord or bony stenosis doing the same, an upper back surgery to remove the pressure is a much bigger and more invasive procedure than even low back surgery. Why? Quite simply, the lungs are in the way. In most procedures they need to be deflated to give the surgeon enough room to operate, which means an instant ICU admission to re-inflate them. As a result, when this patient showed up last year with severe upper back pain, my goal was to see if we could help her avoid the procedure. Because she also had a stenosis component (bone spurs pressing on nerves), we used a procedure that we have been using for some time. The Regenexx-DDD procedure was designed to address one of the major causes of degenerative disc disease (DDD), rather than just the symptoms. Believe it or not, bone spurs and enlarged joints pressing on nerves are a symptom of degenerative disc disease and not a cause. It’s been known since the 1960′s when Cloward introduced his neck fusion technique that bone spurs can go away once the extra motion associated with DDD is stopped. This is the reason we see so many fusion surgeries. The problem is that these spine fusion surgeries are quite invasive and fuse things solid, causing the levels above and below to move too much. Is there a better way? This patient had the Regenexx-DDD procedure several times in 2011, treating both the irritated nerve through injecting her own growth factors into the epidural space as well as injecting those same growth factors into the surrounding ligaments to stabilize the area. She’s not completely finished with therapy and will need another round, but we checked an MRI this past week to check her spine. The MRI image above may take some explaining, but it documents a change not often seen in these patients. In the before image on the left note that SC=spinal cord and FJH=facet joint hypertrophy. In this case her facet joints (the joints that allow movement in the spine) are bigger than they should be (hence the term “hypertrophy”). Here they have grown big enough to press into the spinal canal (see the red arrows) and begin pressing on her thoracic spinal cord. Why did they get that way? Our Orthopedics 2.0 book explains why. She has poor stability at this level, so it’s moving too much and her facet joints are reacting by getting bigger. What are the two major components of stability? Muscular and ligamentous. So to help her, we need to both tighten the ligaments and cause the muscles to get stronger. The Regenexx-DDD procedure involves injecting these ligaments with a growth factor mix that can help to make them stronger. In addition, it involves getting rid of the nerve irritation that’s shutting down the muscles so they can begin to work better as stabilizers. To do this, rather than injecting toxic steroids, we injected her own growth factors. The result? Look now at the picture on the right. The big facet joints (now labeled with “FJ”) aren’t so big anymore and her spinal cord is now surrounded completely by a white color (this is the spinal fluid also called “CSF reserve”). Basically, her bony facet joint stenosis has improved. Is this something that usually waxes and wanes? No, not in my experience of reading tens of thousands of spine MRIs. The upshot? Treating DDD is more than just injecting magic stem cells, you must treat the causes using a Orthopedics 2.0 approach!
NOTE: Regenexx-DDD is a medical procedure and like all medical procedures has a success and failure rate. Not all Regenexx-DDD patients experience this degree of improvement in their bony facet joint stenosis.
PRP injections for back pain? As I have blogged before, we have a big commitment to data collection through our strictly maintained registry. The latest data hot off the presses is for the Regenexx-PL-Disc procedure, a technique used to substitute for common high dose steroid epidurals. In this procedure (click on infographic above to see a bigger version), we use platelet lysate to reduce swelling and provide important growth factors for nerves that are not working well. The most common application is for spinal disc bulges or herniations that cause sciatica, but we also use it for nerve hydro-dissection (freeing up a trapped nerve using a needle to inject platelet lysate under careful ultrasound guidance). The infographic below is our most recent data comparing the Regenexx-PL-Disc procedure to traditional steroid epidurals that are often used to treat radiculopathy (spinal nerve pain due to a bulging or herniated disc). The interesting points are that while 11 patients didn’t respond to steroid epidurals and switched over to the Regenexx-PL-Disc procedure, none switched the other way. In addition, note the dramatically higher increases in patient function with the Regenexx-PL-Disc procedure than with traditional steroid epidural injections. The upshot? We’ve been performing this procedure in one form or another since 2005 and have seen great results as doctors, so it’s nice to see the procedure perform well when comparing registry data with the most common injection therapy for spinal discs.
NOTE: Regenexx-PL-Disc is a medical procedure and all medical procedures have a success and failure rate.
Jarvis Green and Stem Cells is a winning combination. Jarvis Green is a former New England Patriot and Denver Bronco who came to us for his back and his knee issues after a failed micro fracture surgery. We used a combination of the Regenexx-PL-Disc procedure on his back and the Regenexx-SD and -C procedures on his knee. Jarvis did great and went on to play another year with the Houston Texans after being told he was done. That was in July 2010-how is he doing 2 years and 3 months later? This is from an e-mail he just sent us:
” Hello everyone,
My back and knee [have been] doing great and I have been bike riding and also working out in the gym.
I keep my weights light and make sure to do everything with control..
I have to say life after football has been pretty good when it comes to everyday activities and moving around with travel.
I remember before my last treatment at the clinic my back and knees were very achy and sore. I think my back has [allot] to do with how my knees fill.. Back in great condition with no pain/knees do really well..
No surgeries and life is damn good…
Can’t add much more to that…
NOTE: Regenexx-PL-Disc, Regenexx-SD and Regenexx-C are medical procedures and like all medical procedures have a success and failure rate. Not all patients experience the same results as Jarvis Green. The Regenexx-C procedure licensed by RegenexxCayman is not approved by the U.S. FDA for use in the United States. RegenexxCayman is an independently owned and operated medical services provider operating exclusively in the Cayman Islands and is not part of or affiliated with the Centeno-Schultz Clinic or any U.S. Regenexx Network provider.