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Watch a Stem Cell Disc Treatment: Step into Our Procedure Suite with Dr. Pitts

POSTED ON IN Back/lumbar Regenexx Spine Procedures Regenexx-SD BY Chris Centeno

With over 2,000 posts on this blog, I’ve given you a lot of material to read over the years about what we do; however, there’s nothing quite like watching an actual procedure. I hope you are enjoying this series of videos allowing you to step into one of our procedure suites so you can observe for yourself why Regenexx is very different.

Today, I’d like to invite you to stand alongside Dr. Pitts as he performs an advanced image-guided injection into the L4–5 disc of a patient who had an annular tear with low back pain. Let’s take a look at what Interventional Orthopedics looks like in a Stem Cell Disc Treatment.

Terminology Used in the Video

Dr. Pitts does a fantastic job in the video of walking you through the procedure as he performs it. There are, however, some medical terms you may need to become familiar with that will help you follow along as he demonstrates. I have highlighted these below:

Annular tear: The annulus is the outer covering of the disc, and this can develop a crack; this is called an annular tear. This patient’s annular tear is in his lumbar spine in the L4–5 disc. That’s the disc that sits between and cushions the L4 vertebra and the L5 vertebra. If left untreated, the gel inside the disc can cause the torn or damaged area to bulge (bulging disc), or a complete tear can occur, causing the gel to squirt out (herniated disc). Surgeons will often recommend back fusions for disc issues, but this is not something we recommend as this can lead to more problems, such as adjacent segment disease.

Contrast Dye: The injectate (the material being injected) is invisible on X-ray. To ensure it is making it to the precise location intended, contrast dye is injected that can be seen on X-ray. The contrast dye, as you will see in the video, also allows Dr. Pitts to visualize the annular tear, on which he will perform a stem cell disc treatment, injecting the biologic into the tear.

Extravagate: Dr. Pitts uses this term to describe the contrast leaking outside of the limits of a normal interior disc space. In a healthy disc, the contrast stays right in the middle (the nucleus) of the disc, making a clean oval shape on the X-ray image. If there is a tear, the contrast will extravagate, or leak, out of the middle of the disc and into the area of the damage. In this patient, the contrast leaks out of the middle of the disc, clearly highlighting the annular tear.

Intradiscal means within, or inside, the disc. So when Dr. Pitts says intradiscal procedures or treatments, he’s referring to procedures taking place within the disc.

AP view: This is an anteroposterior (front-to-back) X-ray view of the structure, in this case, the L4–5 disc. After injecting the contrast, this picture is looked at to confirm there is proper needle placement in the disc. In this patient, the AP view shows good contrast flow inside the disc.

Lateral view: This is a side X-ray view of the structure, in this case, the L4–5 disc. This is the second step used to confirm proper needle placement inside the disc. The lateral view is also diagnostic: this is the point at which Dr. Pitts will see the contrast leak out of the middle of the disc, confirming the annular tear and allowing him to inject the biologic precisely.

Equipment Seen in the Video

Dr. Pitts is using fluoroscopy imaging, which is a live X-ray, during the procedure. You will see X-ray images as he determines precise needle placement and adjusts as needed. In this video, you will also get a glimpse at some of the lab equipment as the lab technician processes cells. We also give you a quick peek at what one of those one-size-fits-all automated bedside machines looks like; if your provider is using one of these, your stem cell disc treatment is not customized for you.

Vital signs are also monitored during our procedures via a full surgical monitor, and we always have emergency equipment, such as a crash cart, oxygen, and an automated defibrillator on hand. Read more about our standard procedure-suite setup in the second half of this post on amniotic stem cells.

Stem Cell Disc Treatment: Compare and Contrast

Most providers offering stem cell disc treatments in the low back do so blindly. This means that they inject the cells mostly in the low back muscles. They have no way to visualize precise needle placement or no way to get into the disc or facets or any other specific structure.

Also, what separates Regenexx from other stem cell providers performing intradiscal treatments that do use guidance? It’s the ability to customize the treatment for every patient via processing by hand in our in-clinic lab. This is important because patients undergoing stem cell disc treatments will need a high concentration of stem cells in a minuscule volume because the disc cannot handle a large-volume injection. Most providers use simple one-size-fits-all automated bedside machines, which tend to have a smaller number of stem cells in a higher volume, resulting in a much lower concentration in the disc.

The upshot? One of the most important aspects of disc treatment is using the right type of procedure for the right type of disc problem. Some involve platelet procedures to tighten up the ligaments around a disc, or into the facet joints, and some use your stem cells like this stem cell disc treatment for an annular tear, but each is customized to the individual patient and issue. Now that you have seen what we do, I hope you have a clear picture of why Regenexx is very different.

 

    comments

    Jamil Bashir says

    Oscar Worthy Performance Dr. John Pitts!
    Stem Cell Therapies...In your Shoulder, In your Knee...As the Revolution of Medicine proceeds...

    replies

    Dion says

    Thank you for discerning the types of disc problems and the procedure specific to helping with this particular problem. It will help me explore my own historical lower back injuries and how that affects my knee problem. I am so very grateful to you and the professionalism of Regenexx. The educational component to your work is remarkable and I am stunned by the respectful approach of really informing us of our choices and decisions to make regarding our health! Besides helping me make more informed and thereby better decisions, your approach and methods have helped me feel less disillusioned and therefore more hopeful for the future of medical care. It's refreshing to find such integrity in the business world.

    Bravo for another wonderful educational video!

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    Shaun says

    The real question is, how did the patient do postoperatively? I'm not being smart. We need more long term radiologic studies to show that the stems cells work, not just patient felt better postop. I've also read a lot about additives to cells. It seems that a Hyaluronic gel addition with some growth factors might tell the cells what to turn into, and offer repeated exposure to growth factors longer term. I'd def be curious on feedback, here, and if you plan on offering this in the future. I'm in the medical field, but also in need of some regenerative therapy myself, as I have psoriatic spondylitis that has destroyed many levels of facet joints in my back...

    Thanks.

    replies

    Chris Centeno says

    Shaun,
    As you can see the patient did very well postoperatively, as the competition in which he took Gold was 8 weeks after the procedure. This particular patient is part of our Rotator Cuff Clinical Study in which they have exams and MRI's at particular time points over the course of 24 months, so his data wil become part of the results of that study. Hylauronic Acid "Gel Shots" can be a good thing a period of time before a knee stem stem cell injection provided some important guidelines are followed, but not with the stem cells. http://www.regenexx.com/knee-gel-injections/ The right types of growth factors on the otherhand can be a good adition to a stem cell procedure. Please see: http://www.regenexx.com/what-is-regenexx-3/ If you'd like us to take a look and be evaluated for a regenexx procedure, please submit the candidate form. http://www.regenexx.com/the-regenexx-procedures/back-surgery-alternative/

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    About the Author

    Chris Centeno

    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.…

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