A Case Study Highlighting the Regenexx Flexible Lab Platform
POSTED ON 6/3/2017 IN Regenerative Medicine Education BY Christopher Centeno
In the world of regenerative medicine, the vast majority of providers out there are using one-size-fits-all kits and bedside machines to process orthobiologics (stem cells, platelet rich plasma, etc.). These kits are usually only designed to make one thing. So they are inflexible. The problem is that patients come in with all sorts of problems to be treated. Hence, oftentimes, what needs to be treated in the patient doesn't match what the kits can do. This is a case study that shows how the Regenexx flexible lab platform can be as flexible as needed to accommodate a wide variety of patient conditions. This matters if you're a patient or the doctor tasked with treating all of these things.
A 30,000 Foot Example of the Problem with One Size Fits All Bedside Kits
A patient comes in for a same day, bone marrow stem cell procedure to treat a painful low back disc that requires bone marrow concentrate (BMC). The most commonly used kit starts with 60 ml of bone marrow aspirate and produces 10 ml of BMC. Regrettably, the patient's low back disc will only take 1-2 ml. How do these bedside machines concentrate 60 ml of bone marrow into 1-2 ml of stem-cell-rich bone marrow concentrate (BMC)? They can't, so at least 8 ml of the 10 ml BMC is wasted. At Regenexx, we can because we don't use kits and bedside machines; we use a flexible lab platform that can deploy any number of regenerative medicine technologies and customize and concentrate the orthobiologic to the patient's need. A case study of one of my patients this week highlights how the Regenexx flexible lab platform really shines.
The Regenexx Flexible Lab Platform: A Case Study
My patient this week is a 65-year-old woman who had a number of issues going on. In the left shoulder, she had a partial supraspinatus muscle tear in two places (one that included about half of the supraspinatus tendon). In the right shoulder, she had supraspinatus tendinosis. She had lateral epicondylitis (tennis elbow) in both arms, and she also had cervical radiculopathy (pinched nerve in the neck) in her spine. Her left supraspinatus tears were going to require a high-dose BMC. I'd previously treated her right sided rotator cuff tear with BMC with great success, but the new tears on the left had aggravated and put more stress on the right shoulder because she was unable to use her left side. Her treatment plan also included platelet rich plasma (PRP) for the bilateral epicondylitis and platelet lysate (PL) for the cervical radiculopathy. So her at-a-glance full treatment plan looked like this:
- Two left-sided partial supraspinatus tears—high-dose BMC with PRP and PL
- Right-sided supraspinatus tendinosis—PRP at 10X
- Bilateral lateral epicondylitis—PRP at 7X
- Cervical radiculopathy—high-dose PL
What These Procedures Would Look Like Using One-Size-Fits-All Machines
If I were using these one-size-fits-all machines, this full procedure would require a lot of equipment. Here's what would happen:
- I could use one machine and several kits to concentrate the PRP (but, unfortunately, to get to these higher concentrations, I would need to double or triple spin that machine, which would invalidate the machine's concentration protocol).
- I could use the PRP machine to make BMC (again, invalidating the machine's protocol). The issue is that the PRP machine isn't really purpose designed to make BMC, so it will do a poor job.
- I could use a separate machine and kit to make the BMC (yet again, I would need to double or triple spin that machine, as I want high dose BMC, invalidating the machine's concentration protocol).
- I can't make the high-dose PL in a machine; I need a lab.
So let's delve deeper into my problems with bedside machines. Just looking at the BMC in this situation here's my problem: I need to get a high-dose BMC. I've drawn 60 ml of bone marrow aspirate, and my patient's tear is only going to require 2 to 3 ml of bone marrow concentrate. How do I concentrate all of those stem cells in the 60 ml sample into 2 to 3 ml using a machine? I don't…unless I want to double or triple spin the machine invalidating its protocol. And what about the platelet lysate, which I need for two of my patient's issues? I can't even make that with my bedside machines. It's clear I'm going to need a lab that can customize what I need—a flexible lab platform that can concentrate all of those stem cells into the 2 or 3 ml I need—and thank goodness I have one.
What This Procedure Looked Like Using the Regenexx Flexible Lab Platform
Our flexible lab platform allowed me to customize all of the orthobiologics I needed for this patient in the precise concentrations required. In addition, I was able to make some of the PRP and PL from her bone marrow aspirate, which was imperative for this patient because she was borderline anemic. So I was able to reduce the volume of blood in her blood draw to keep from removing too much blood from this patient. I wouldn't have been able to adjust for her anemia using a bedside machine and wouldn't have been able to accomplish her full treatment in one procedure. The upshot? As this case study shows, this procedure really couldn't have been accomplished with the one-size-fits-all machines and kits. The Regenexx flexible lab platform is yet another reason that Regenexx is very different. It allows not just me but the entire network of Regenexx physicians to customize treatments to each patient's specific need.
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