It seems to be the latest craze; all the cool providers, most after taking a weekend course, are doing it. So should you get your disc injected with stem cells? The question certainly seems simple enough; however, the answer is a bit more complex. This isn’t a new fad for us. We were the first in the world to inject stem cells into discs, and over the past dozen years, we’ve learned a few things along the way. The short answer is, it’s not frequently as simple as just treating the disc. Let’s first review the anatomy of the spine, and then I’ll explain this answer in more detail.
To enhance your understanding of the anatomy of the spine (as well as the disease processes I’ll discuss throughout), be sure to watch the video above as it contains helpful visuals. First, your discs sit between your vertebrae, the spinal bones, and act as shock absorbers for those vertebrae. You also have facet joints that run along the back of the vertebrae, occurring where every two spine bones articulate. There are spinal nerves that come out at each facet joint level, one on each side. The multifidus muscle provides stability for all of the spinal structures, and there are ligaments that provide a different kind of stability.
So when should you get your disc injected with stem cells? There are a couple of scenarios in which a stem cell injection into the disc makes sense and can be very helpful. First, if there’s a painful tear in the disc and the disc itself is definitely causing the pain. Patients who have this issue typically can’t sit very well due to pain. Second, if a torn disc is leaking chemicals onto the nerve and this is irritating the nerve. You can take a look at our own Dr. Pitts in one of our procedure suites performing an actual stem cell injection for a torn disc at this link. In both of these instances, the disc still has good height and hasn’t yet collapsed.
Another disc problem that may warrant a stem cell injection is when a disc bulge compresses a spinal nerve and that can’t be managed with injecting platelet lysate around the nerve (epidural). However, in our experience, getting rid of this type of disc bulge requires specially cultured stem cells that aren’t available in the US. We only use these special cells at our licensed advanced cell culture site in Grand Cayman.
There are a few other scenarios that are very common in which a stem cell injection into the disc simply doesn’t make sense as patients with these conditions can often be treated without injecting directly into the disc. These include a herniated disc or a tweaked spinal nerve. In these cases, our experience has shown us that it’s best to treat with a precise X-ray–guided injection of healing growth factors right at the spot of the irritated nerve. This is called a platelet lysate (PL) epidural, and we’re on our fourth-generation PL. This type of treatment can often also be used to manage a disc bulge irritating a nerve.
However, any of these conditions may require treating more than the disc and/or the nerve. The stabilizing muscle called the multifidus can shrink. This can cause active instability, which then tweaks the nerve and causes more multifidus atrophy. So this may need to be treated separately to restore spinal stability. The facet joints can also get injured, and these may also need to be treated. Ligaments that provide passive stability can get loose, and they can cause the vertebrae to slip. Those ligaments may need to be tightened down through an injection. The key is to use the right treatment for the right type of problem.
When the disc loses its ability to hold onto water, it collapses, the facet joints get arthritis, the multifidus shrinks, and the ligaments get lax. These are signs of a whole spine disease. It’s not just a disc disease, so injecting stem cells into the disc here is not going to do much. In order for your treatment to be successful, your provider is going to have to deal with all of your spinal issues at once: the nerves, the discs, the multifidus, the loose ligaments, and the irritated facet joints.
We see cases where doctors have injected stem cells into the discs of patients who really have a whole spine disease with a collapsed disc, and, understandably, the patients aren’t getting much relief. So why treat the whole spine in these cases? Because if your provider really focuses on treating the entire spine and all of its different parts, he or she can provide much more successful treatments for patients.
Of all of the types of complications that can happen with a low back injection, perhaps the worst is discitis. This means that the disc gets infected. If this happens, it’s a big deal requiring IV antibiotics and likely surgery. Hence, staying out of the disc if it doesn’t need to be injected, is always the best move.
The upshot? Should you get your disc injected with stem cells? The answer is just because all the cool providers are doing it, it doesn’t mean it’s the best treatment for your condition. Based on our extensive experience, stem cell treatments in the disc do work well, but it’s imperative that these treatments be used in the right patients, such as those with pain due to torn discs or torn discs leaking chemicals onto the nerve or a disc bulge that can’t be managed in any other way. In many patients, treating several areas of the spine (nerve, facet joint, multifidus, etc.) with advanced orthobiologics (stem cells, advanced platelet treatments) outside the disc works better than treating just the disc.
About the Author
Christopher J. Centeno, M.D. is an international expert and specialist in regenerative medicine and the clinical use of mesenchymal stem cells in orthopedics. He is board certified in physical medicine as well as rehabilitation and in pain management through The American Board of Physical Medicine and Rehabilitation.…