Blog | The Regenexx™ Procedure

One Year Post Op on a Low Back Disc Bulge Treated with Stem Cell Injection

February 3rd, 2010

One of the problems with damaged discs is that they tend to go one direction, they degenerate with time. This is one of the big issues for most patients who have low back surgery (laser spine surgery included, micro surgeries, minimally invasive low back surgery, to the disc it’s all the same). Since the surgeon removes parts and pieces of the disc (again doesn’t matter if it’s vaporized with a laser or pulled out with a surgical instrument), the disc continues to collapse in height and lose water (likely at a faster pace due to the surgery). We get a short term gain (less pressure on a nerve) and create a bigger long-term problem (the disc now degenerates faster) As it does this and the years pass, more arthritis forms and this can press on more nerves. In the end, the cells inside the disc die off with time. Not so long ago, I blogged on an animal paper which showed that mesenchymal stem cells, when re-implanted into a degenerated disc, stopped the progression of degeneration in it’s tracks. Yesterday, we got one year follow-up films back on an a study patient who had her large L5-S1 disc bulge treated by injecting stem cells into the bulge, rather than surgery. The films below show that the disc bulge is still smaller than it was before the stem cell injection and perhaps getting a bit smaller:

stem cell injection into low back disc to avoid low back surgery

If you look at the before image to the left (above), the disc bulge is bigger before stem cell injection, the one year follow-up after stem cell injection on the right shows a smaller bulge. While that’s great news, the more interesting issue is what happened to the non-treated L4-L5 disc. This disc serves as a control, meaning what happens to it is what the treated disc should be doing if it continued to degenerate. What’s happening to the non-treated disc above the treated disc?

stem cell injection to avoid low back surgery

The untreated disc (L4-L5) has indeed continued to degenerate as expected. In the MRI’s above, it’s lost 1 mm in height and has a bigger bulge as well as seems to be holding onto less water (darker on MRI). What happened to the treated disc during this time? No loss in height, no loss in water content, disc bulge size is still smaller than pre-treatment. This is interesting, as it may mean that the normal degenerative process (discs get darker, lose height, and bulge more over time) has been slowed or possibly stopped for now.

Tags: avoid, buldge, bulge, disc, don't want, injection, low back, stem cell, surgery, therapy, Treatment, treatments
Posted in Back/lumbar | No Comments »

Knee Meniscus Tear treated without Surgery

January 27th, 2010

Greg is a 51 year old who fell from a ladder and tore the back part of his medial meniscus (radial tear of the posterior horn of the medial meniscus). Greg limped around for three months and then decided he didn’t want surgery. Instead, he presented to our clinic and we determined on exam that this was likely the cause of his pain. As you know, research now shows that knee meniscus tears are not always the cause of pain, so a good exam is now needed to make sure. He decided to avoid surgery and have his own stem cells harvested, grown in culture, then injected under imaging guidance into the tear. He was seen for a series of injections, and 6 months out from these, he reported this week 100% improvement in his knee pain symptoms and a significant improvement in function. As a another discussion, a different patient seen yesterday in clinic needed adjustments in his treatment plan beyond the meniscus. This patient also had a significant meniscus problem, which was treated during his first two procedures. This area significantly improved. However, it was detected on his exam that he has ongoing instability in this knee due to a lax ACL (anterior cruciate ligament) and tendinitis in his patella, which left him with continued anterior (front) knee pain. As a result, we needed to change the placement of cells from the meniscus to the ACL and patellar tendon to treat these secondary issues. So while the first case was smooth sailing from the start, the second patient had knee instability that needed treatment in addition to the meniscus. This brings up the importance of specific targeting of certain knee structures versus just blind injections in the joint. The research in this area supports that specific placement of cells would be more effective than just blindly injecting cells into the joint. This second patient also brings up the ortho 2.0 concepts I have blogged on in the past.

Tags: avoid, injection, Knee, meniscus, platelets, prp, stem cells, surgery, tear, tore, torn
Posted in Knee | No Comments »

Stem cells injected to treat thumb arthritis

January 25th, 2010

Larry is a 60 year old male with severe arthritis in his CMC joint (base of thumb). He was unable to button his own shirt due to pain. I think this patient update is a good follow-up to the last blog, which discussed surgically removing a wrist bone to treat thumb arthritis (the space fills in with scar tissue). He was offered surgical options, but chose to have his own adult stem cells injected into the joint rather than surgery. This morning he reported 90% improvement at 6 months after his procedure, and the ability to button his shirt again. We had Larry at a FAIR candidate for the procedure (we use GOOD, FAIR, POOR for patients who are considering the procedure), which to us means that while the procedure may be successful, there is a significant chance of failure. We continue to grade patients for the procedure more pessimistically than is likely necessary, because we believe that until we have more data analyzed, it’s better to stay conservative. Also realize that Larry had no surgery, only an x-ray guided injection pre-injection and then injection of his own stem cells, with limited downtime. He wore a splint for a week after the injection, but had no prolonged immobilization. We will continue to track Larry’s outcomes, but his results are consistent with other patients we have treated for thumb arthritis.

Tags: arthritis, avoid surgery, balck berry, basal, blackberry, CMC, injection, joint, pain, stem cells, texting, Thumb
Posted in Thumb | No Comments »

Removing the Trapezium Bone to Help Thumb Arthritis?

January 19th, 2010

thumb surgery remove trapezium bone

In the truth is stranger than fiction category this morning is a patient who discussed that her surgeon was planning on taking out an important wrist bone to solve her thumb CMC arthritis problem. Arthritis at the base of the thumb (black berry or texting thumb) is a common problem these days. The trapezium bone is in the yellow dashed circle above (‘E”) in the diagram above, and lives at the base of the thumb joint (CMC). The theory is that yanking this bone out will remove 1/2 of the painful joint and the area will fill in with scar tissue. This surgery can be done in such a way as to spare the surrounding ligaments. The problem is that the carpal bones are needed to help coordinate proper hand function and the wrist joint is one of the body’s most complex areas. Yanking out an important piece of the wrist may help with a short term reduction in pain, but will permanently alter the biomechanics of the wrist and likely lead to more arthritis in more of the wrist. In addition, once the bone is removed, there is no going back. While this surgery may help reduce pain, I’d have to put it in the same category as many surgeries that try to improve upon the body’s function by removing critical parts, a bad idea. Think about if your mechanic came to you with an extra part in his hand after “fixing” your car. He tells you that you really don’t need this part and that you can get an extra 1,000 trouble free miles out of it as a result of him removing the part. You ask him what happens after that? He tells you that he’s not exactly sure, but he thinks that as a result of removing the part, he’ll have to perform a major rebuild of your engine. I think it’s clear that most of us wouldn’t take the trade off.

Tags: arthritis, hand, pain, removal, scar, surgery, Thumb, tissue, trapezium, wrist
Posted in Thumb | 1 Comment »

Hip AVN / ON (Avascular Necrosis – Osteonecrosis) Outcomes

January 15th, 2010

hip avn osteonecrosis outcomes stem cells stem cell prp

Over this next few months we will be reviewing our large outcomes database and (now about 350 patients and almost 800 procedures) and reporting on the preliminary data in this blog as well as publishing multiple large case series. Today the focus is on Hip Avascular Necrosis (AVN or osteonecrosis) patients and how they have fared. This is a select group of 27 patients from a specific time period. We measured the patient reported results in these patients who were all told they needed a hip replacement. Instead of the hip replacement surgery, we injected their own mesenchymal stem cells into the bone via x-ray guidance, a procedure with much less downtime than even a surgical CORE decompression and certainly less invasive than a hip replacement surgery. Of the 27 patients, 4 were lost to follow-up (couldn’t get outcome information), and 3 went on to hip replacements so their data was removed as any results might be due to the hip replacement. All patients were between 3 months and more than a year out from their stem cell injection. Of the 20 remaining patients, approximate mean reported improvement was 50%. While we intend to clean up this data further and report this by disease severity (ARCO grade 1, 2, 3, 4+), I thought this was interesting information to report.

In the meantime, we continue to look at other types of patients such as knee osteoarthritis, hip OA, shoulder, rotator cuff, etc… Again, this is preliminary data.

Tags: avascular necrosis, AVN, avoid surgery, Hip, injection, ON, osteonecrosis, stem cell, stem cells
Posted in Hip | No Comments »

Is Platelet Rich Plasma Effective?

January 13th, 2010

Is PRP effective?

Recent study on PRP for Achilles tendinitis. It showed PRP was no more effective than placebo injections. While we’re not big believers that PRP is that much moire effective than less expensive procedures like prolotherapy, this study has problems. The placebo was equivalent to a percutaneous tenotomy, where you injure the tendon with a needle to try and get it to heal. What the study did show, is that for most patients, adding in PRP was no better than a standard micro injury technique for tendons (which likely works well by itself without PRP added). I still believe that for some patients the addition of PRP makes a difference, but this study does pop the balloon a bit on the idea that PRP is magical stuff.

Tags: effective, effectiveness, help?, outcome, plasma, platelet, prp, rich, work?
Posted in Medical alternatives, stem cell | No Comments »

Regenexx featured in the Boulder County Business report

January 8th, 2010

Regenexx orthopedic stem cell injections were featured in the Boulder County Business report this morning.

Tags: boulder, centeno, colorado, injection, injections, orthopedics, stem cell, stem cells
Posted in Latest News | No Comments »

Shoulder Arthritis and Rotator Cuff Tears

January 8th, 2010

JS is a 47 year old male with a 1.5 year history of shoulder pain who due to his arthritis, labral tear, and multiple small tears in his rotator cuff tendon. He was told he would likely need a shoulder replacement. In our experience this is a very big surgery with relatively poor clinical outcomes, as most of the patients we’ve seen through the years have had significant pain and disability as a result of shoulder replacement. We treated his shoulder rotator cuff and shoulder joint by re-injecting his own mesenchymal stem cells into the joint and rotator cuff under x-ray guidance. The good news is that we appear to have saved him a surgery. He reported significant improvement and after several rounds of treatment, he wanted to continue. We requested a repeat MRI to make sure we were on the right track. Dr. Schultz reviewed that MRI this week and the most striking results are above. The before picture on top, shows the supraspinatus tendon below the yellow arrows. The problem is that in November of 2008, the extensive light colored areas in the tendon represent swelling and tears. The good news is that the after picture below, now shows that the rotator cuff tendon (under the yellow arrows) has much improved dark colored signal on this similar STIR MRI image. This corresponds with his reported clinical improvement. In addition, the bone cysts that he had in the head of his humerus, can no longer be found on the follow-up MRI. He was cleared to continue treatment.

Tags: injection, muscle, rotator cuff, Shoulder, stem cell, tear
Posted in Shoulder | No Comments »

Safety and Complications Reporting on the Re-implantation of Culture-Expanded Mesenchymal Stem Cells using Autologous Platelet Lysate Technique

January 4th, 2010

Here is the abstract of the paper recently published by Dr. Centeno and Schultz. You can read more here.

Mesenchymal stem cells (MSCs) hold great promise as therapeutic agents in regenerative medicine. Numerous animal studies have documented the multipotency of MSCs, showing their capabilities for differentiating into orthopedic tissues such as muscle, bone, cartilage, and tendon. However, the complication rate for autologous MSC therapy is only now beginning to be reported. Methods: Between 2005 and 2009, two groups of patients were treated for various orthopedic conditions with culture-expanded, autologous, bone marrow-derived MSCs (group 1: n=45; group 2: n=182). Cells were cultured in monolayer culture flasks using an autologous platelet lysate technique and re-injected into peripheral joints (n=213) or into intervertebral discs (n=13) with use of c-arm fluoroscopy. While both groups had prospective surveillance for complications, Group 1 additionally underwent 3.0T MRI tracking of the re-implant sites. Results: Mean follow-up from the time of the re-implant procedure was 10.6 +/- 7.3 months. Serial MRI’s at 3 months, 6 months, 1 year and 2 years failed to demonstrate any tumor formation at the re-implant sites. Formal disease surveillance for adverse events based on HHS criteria documented 7 cases of probable procedure-related complications (thought to be associated with the re-implant procedure itself) and three cases of possible stem cell complications, all of which were either self-limited or were remedied with simple therapeutic measures. One patient was diagnosed with cancer; however, this was almost certainly unrelated to the MSC therapy. Conclusions: Using both high field MRI tracking and general surveillance in 227 patients, no neoplastic complications were detected at any stem cell re-implantation site. These findings are consistent with other reports that also show no evidence of malignant transformation in vivo, following implantation of MSCs that were expanded in vitro for limited periods.

Tags: complications, problems, safety, side effects, stem cell, stem cells
Posted in Latest News | No Comments »

Happy Hip Pain Holiday

December 18th, 2009

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This may be my last post before going on vacation for the Christmas holiday. Just received this e-mail from a patient with severe hip arthritis who was treated by injecting her own, culture expanded stem cells using the Regenexx procedure here in Colorado. Again, we don’t claim to have a 100% success rate and this is a new procedure (hence the insurance comments), but I thought that this is the best type of holiday card a clinic like ours can receive, so here’s the copy/paste:

“Happy Holidays!….I’m so glad to have completed all my treatments. My margin of improvement is HUGE. I’m so thankful the doctors were able to releive the pain I experienced 24/7. This has been the best gift ever!!! Having said that I know insurance doesn’t want to pay for this stuff…but I feel obligated to hassel them a little. It’s just wrong they would so easily pay for some expensive barbaric surgery and not stem cells…I feel they need to become aware of alternatives. Thanks, D”

Tags: arthritis, Hip, hippain, osteoarthritis, stem cell, stem cells
Posted in Hip | No Comments »