A Different Way to Approach a Bulging Low Back Disc
POSTED ON 1/7/2011 IN Spine BY Christopher Centeno
Bulging low back discs that press on nerves are tough to treat with physical therapy and just 10 years ago, the vast majority were operated with back surgery. More recently, steroid epidurals have been used. The concept behind low back epidural injections is that the steroid medication will reduce swelling around the nerve. This generally works reasonably well to help patients avoid surgery. One of the downsides of steroids however, is that the high dose steroid medication injected can cause problems (like excessive epidural fat formation, causing more pressure on the nerve as well as cushings syndrome (which I have seen twice in my career from epidurals)). I recently blogged on studies showing that these high dose steroid shots being bad for tendon injuries. Is there another way? Can we treat a patient's disc bulge using more modern regenerative techniques? While platelet rich plasma may be a good candidate, nerves are sensitive and platelet bodies can cause swelling and inflammation, which may work in a tendon, but could be a bad day for everybody around a nerve. We've tried other blood preparations like IRAP (specially incubated blood plasma), but with generally poor results. To get to a regenerative solution for disc bulge patients and avoid the pro-inflammatory effect of platelet bodies, we created the Regenexx-PL procedure. In this procedure, our physicians crack open the platelets to get instant access to all of the growth factors and filter out the pro-inflammatory platelet bodies. How does this work? Our experience has been better and longer lasting results in most patients than injecting the traditional high dose corticosteroids. Here are two examples: -TA is a 44 athletic female with a failed neck fusion who developed low back pain 4 months ago which she described as "knife like". This pain wasn't helped by physical therapy, trigger point injections, nerve pain medication, and narcotics. The patient didn't want low back surgery due to her poor neck fusion result. Her EMG showed nerve problems and her MRI showed a a diffuse disc bulge at L4-L5 with possible pressure on the right L5 nerve root and a disc herniation at L5/S1 (7 mm) with pressure on the S1 nerve root. After three Regenexx-PL injection procedures (epidurals) the patient reported 100% relief of her right leg pain and 90% reduction of her low back pain. -DD is a 30 year old athletic male with a 2 month history of right sided low back and leg pain. He failed conservative care including chiropractic. His MRI showed reduced height of the L5-S1 disc with a large right sided disc extrusion (11 X 8 mm) displacing the S1 nerve root. After three Regenexx-PL injections, the patient reported an 80% reduction in low back pain and a 40% reduction in leg pain. He has put off surgery for the time being and returned to more activities. At later follow-up the patient reported to Dr. Schultz: "Thank you for your follow-up. I would say there has been additional improvement. I do have some intermittent discomfort in my right buttocks and some down the right hamstring. But it appears less and less frequent over time." This reduction in pain as time goes on, we've noticed clinically, is more frequently reported with Regenexx-PL epidural procedures than steroid epidurals. We believe this is because Regenexx-PL contains growth factors like VEGF that help the formation of new blood vessels, which takes weeks to months. Do all Regenex-PL patients report these home run results? NO. This procedure is a clinical tool with a success and failure rate. However, we generally note better results from Regenexx-PL epidurals than steroid epidurals.
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