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.
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.
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.
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.
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.…