Nerve Regeneration - The Future Doesn't Involve Surgery

Nerve Regeneration – The Future Doesn’t Involve Surgery

nerve regeneration

Regenexx first began treating injured nerves using orthobiologics delivered via ultrasound guidance in 2012. However, the concept that a precise injection can help nerve regeneration was so revolutionary that we were reluctant to really shout it from the roof tops until we had enough experience under our belt to be sure that it was working. After a few years of seeing nerve injury patients consistently respond to this therapy, I think it’s time to share some of our results and finally declare our confidence in this new procedure that may change how doctors treat nerve injury and entrapment, now and in the future.

Regenexx History with Nerve Regeneration

Our history with the nerve regeneration procedure begins with a different take on platelet rich plasma (PRP), which is the concentration of platelets from a blood sample. Unlike almost all clinics that use PRP, we’ve always had another platelet-based treatment available called platelet lysate (PL). Unlike PRP which can be pro-inflammatory, PL is anti-inflammatory. As industry leaders in regenerative medicine and related research, we’ve noted that this growth factor cocktail works particularly well around nerves. As a result, we’ve been using PL in the epidural (spinal column) space since around 2007 with great results, mostly for patients with sciatica (radiculopathy). As a result, our many successes with PL have driven us to perform the lab research necessary to create successively more powerful versions of PL (we’re currently on our 4th generation version).

What is PL and why is it so special? Platelet lysate is made up of the healing growth factors isolated from platelets and resuspended in a growth factor and cytokine rich serum. As discussed above, we’ve been perfecting how to make PL for many years, regularly increasing its growth factor content beyond the simple PLs we first used back in 2007 (which is essentially what some other doctors are just beginning to use).

How Can Platelet Lysate Injections Help Regenerate Nerves?

A critical part of the nerve regeneration procedure is precise ultrasound guided hydrodissection. This involves visualizing the nerve under ultrasound guidance and using a small needle to inject small volumes of PL around the nerve. Effectively, the doctor is breaking up scar tissue around various parts of the nerve and freeing it up. This can be critical, as many times nerve entrapments and trauma involve scarring around the nerve that compress the structure. Think of a garden hose and how the water flows through it. A nerve is a similar thing in that it transports nutrients down it’s length. If you step on the garden hose, less water comes out the end, just like a nerve that’s entrapped and scarred, with less nutrients making their way down the nerve. Hydrodissection is like releasing that pressure on the garden hose.

Outside of the mechanical effects of breaking up scar tissue, we believe the growth factors in PL can help nerve function. One of those natural compounds is called vascular endothelial growth factor or VEGF and is responsible for causing the body to create new blood vessels. Nerves have a blood supply like any other tissue and much of that lives on the outside of the nerve. When nerves have pressure placed on them, that blood supply can be cut off, reducing oxygen to the nerve. So creating new blood vessels around nerves may be important in nerve regeneration.

Why Patients Want to Avoid Nerve Surgery Whenever Possible

Surgery to get rid of nerve entrapment is generally not a good idea. I can’t tell you how many patients we’ve seen through the years who have gone through these surgeries with no results, or who have developed new problems related to the surgery. In fact, research has shown that one of the world’s most common nerve entrapment release surgeries, Carpal Tunnel Release, destabilizes the bones of the wrist, due to the surgery cutting a critical ligament that is required for wrist stability.

Trying to repair nerves by cutting them and splicing them back together with micro-surgery is notoriously difficult. Nerves are incredibly complex structures, so getting this surgery just right is hit or miss. This is why the better option is to free up some space around the nerve and give growth factors the opportunity to help the nerve accomplish it’s own regeneration.

Clinical Results Speak for Themselves

We’ve seen Regenexx Procedures time and time again get rid of carpal tunnel syndrome (entrapment of the median nerve at the wrist) without surgery. We’ve observed it help a patient regain radial nerve function. We’ve also witnessed it treat ulnar nerve encampments at the elbow, femoral nerve entrapment at the thigh, as well as tarsal tunnel at the ankle. All through a needle and without the need for invasive surgery.

Case in Point

To give you a better sense of how revolutionary this new procedure can be, I’d like to highlight a recent nerve regeneration patient treated by Dr. Pitts in our Colorado clinic. MS is a 57 year old male who presented to our clinic after a fall from a ladder, sustaining a fracture of his left humerus (upper arm bone). With this injury he also injured the radial nerve (nerve that gives signal to the muscle that causes wrist extension and sensation to the back of the hand). He had surgery to repair the fracture, but the radial nerve was severely injured so he was left with “radial nerve palsy”, meaning that the muscles that the nerve supplied no longer worked well. He was unable to move his fingers and wrist in extension and had numbness and burning pain in the back of the hand. The surgeon offered no physical therapy and informed him that it was unlikely that he would return to playing golf, one of his life long passions. This is because nerves heal very slowly and typically can take 1-2 years to return minimal function back to muscles.

We sent him for nerve conduction tests (NCS/EMG), prescribed specific nerve medication to help with his pain, hand therapy and bracing to prevent wrist contracture (when the joint becomes stuck in a nonfunctional position).  These are all the things his surgeon could have offered immediately, but didn’t. Regrettably, the nerve conduction studies showed a damaged radial nerve. At 6 weeks out from his injury we treated him with the new Regenexx procedure for nerve regeneration (hydrodissection of the radial nerve with our fourth generation  PL). Within 2 weeks of the first procedure he began noticing an increase in finger movement. He ultimately received 4 treatments over 6 months and below is his update at 9 months after his initial injury:

“I do not believe my recovery is a miracle!  I am convinced it is the result of sound medical science and skilled treatment.  My orthopedic surgeon and neurologist gave me little chance of resuming playing golf, due to my radial nerve palsy, emanating from a fractured left humerus.  The surgery to repair this injury required 9 screws and a plate.  My drooping left wrist and lack of any sort of fine motor skills with my hand were evidence of that.  Now, nine plus months after injury and seven plus months after beginning treatment, I now have 95% use of my wrist and 85%+ use of my hand.  My key indicator with regard to re-establishing my coordination is my golf handicap.  My handicap has grown from 3.8 to 4.9 and my low score post injury is 75 (twice), 3 over par.  My best the previous year was even par 72 (twice).  Golf is an extreme hand-eye coordination sport and I believe a good indicator of the level of recovery for my dexterity, strength and fine motor skills…I believe the nerve hydrodissection in four treatments has produced remarkable results.  Progress has now slowed, but is still proceeding.”

Coincidentally, this week we received another update from the patient, who is now 12 months post injury:

“Other than mild stiffness, my hand is about 90-95% of pre-accident condition.  Fabulous!”

We also repeated the nerve studies (NCS/EMG) and these showed objective and marked improvement of the nerve’s function.

The upshot? Nerve regeneration through precise guidance is revolutionary. We’ve seen enough great results with this procedure and we feel comfortable letting more patients know it’s available. There’s nothing quite as satisfying as seeing a patient who can’t move muscles because of a nerve injury, regain those capabilities as a result of what you were able to do as a physician. This is doubly so when they told you in medical school that things like this were impossible! At least my medical school dean was smart enough to also tell us, “about half of what we’re teaching you will be declared to be wrong at some point in your career”.

NOTE: Our clinical focus is on helping nerves that have been injured or become entrapped. Nerves that are cut in half with large gaps are likely too severe for this procedure.

 

*DISCLAIMER: Like all medical procedures, Regenexx® Procedures have a success and failure rate. Patient reviews and testimonials on this site should not be interpreted as a statement on the effectiveness of our treatments for anyone else.
Read 78 Comments
    1. Donna,
      They are both compression nerve issues and sometimes the words are used interchangeably. Yes, this treatment can help.

    1. Anthony,
      No, it hasn’t. No, MS is a different type of nerve issue. This treatment is designed for nerve compression issues, meaning the nerve has been damaged due to the physical force of something.

  1. Husband had knee surgery 7-22-15. Resulting nerve damage is very uncomfortable for him. Will this treatment help him? Is this procedure covered by Medicare?
    I need knee surgery (bone on bone- determined severe by Dr) I don’t want to have knee replacement . Am I a candidate ? Also have 5 ruptured disc and stenosis. I had back surgery and it left me worse than before surgery. Will thus procedure help this?

    1. Florence,
      No stem cell procedures are covered by Medicare or Medical Insurance in the USA. In reference to the nerve damage resulting from your husband’s knee surgery, it depends on the type of nerve damage. We have been successful in treating compression nerve injury. If a nerve has been severed, this will not help. Bone on bone knee arthritis is something we treat daily. What type of back surgery did you have? Depending on what type of back surgery was done, Regenexx PL, which is a proprietary platelet procedure designed to treat Discs might be able to help. You can also private message us at https://www.facebook.com/Regenexx/ by clicking on the message button on the lower right of the scenic image.

    1. Mark,
      Bilateral levels like L3-L4 and L4-L5 would be $849.00 + $400.00 =$1,249.00
      One level- L3-L4 or L4-L5 would be $599.00 + $200.00= $799.00

    1. Frank,
      We treat Carpal Tunnel Syndrome and Thoracic Outlet Syndrome regularly. This link will take you to several blogs written on Carpal Tunnel Syndrome: http://www.regenexx.com/?s=carpal+tunnel+syndrome, and this how we treat it: http://www.regenexx.com/the-regenexx-procedures/hand-surgery-alternative/. TOS: http://www.regenexx.com/hands-numb-while-sleeping/ and http://www.regenexx.com/the-regenexx-procedures/shoulder-surgery-alternative/

  2. Left a comment earlier about cost of PL. Someone responded with billable to insurance if in network, just spoke with someone from your office and they told me that no regenerative procedures are covered under insurance.
    Confused?

    Thanks,
    Mark

  3. I was in an accident 2 1/2 years ago. I have a brachial plexis nerve injury. I had a nerve transfer in Nov. 2013. I gained use of my tricep and my wrist, but not my hand. I was told that the muscles had set up atrophy and the nerve did not regenerate in time. I then had a tendon transfer to my hand and fingers. I have very little finger extension and movement. Can stem cell therapy help regenerate the nerves and revive the muscles?

    1. Ann,

      I think it’s really important to discern what is and isn’t possible so that we inform your search forward, rather than giving false hope. I did inquire of Dr. Centeno. His reply:

      “I think it’s unlikely that given your extensive history that we would see return of muscle function in the hand using our procedure to help the nerves. I also think it’s unlikely that stem cells would help.” ~ Dr. Centeno

  4. Barb, back on December 11, 2015, mentioned this could help with neuropath. How about more specifically familial peripheral neuropathy, and how can I found out more details?

    1. Jo,

      Yes, generally speaking we can treat the Pudendal nerve at Regenexx Headquarters in Broomfield Colorado. If you’d like to see if your particular situation would be a Candidate for a procedure, please submit the Candidate form so we can discuss. http://www.regenexx.com

    1. Urvish,
      Our practice and research is exclusively in using stem cells in Interventional Orthopedic application. There is some research going on re ischemic optic nerve treatment. This search term, “ischemic optic nerve stem cell treatment pubmed”, will bring you a series of published papers on the topic.

  5. I have had 4 back surgeries am fused at l4-5 I have fusion at c5-6-7 I have good emgs but I still get pain in rt leg and lft arm with occasional numbness in both would your treatment help I’m years out on both neck and back surgeries . I’m 52 yr old male thanx

  6. I had the parotid salivary gland removed due to cancer. The right side of my face droops badly. It has been one year and no improvement. The surgeon is sure that he did not cut or damage the nerve. I believe he may of had to move it as the tumor was under the nerve. He says he traced the nerve both ways and could see no problems. He says that he has never seen a case that did not recover within less than one year. Is it possible that your treatment could help this?

  7. At 86 years old, am I a good candidate for any stem cell treatments? My feet feel like I’m walking on water most of the time and my balance is terrible. I’ve had double-knee replacement surgery (2002) and a laminectomy/fusion back surgery (2012). My foot flopping started after my knee replacements. I also have restless leg syndrome. I’m currently undergoing testing for possible bone cancer (PET Scan showed spots at hip and at L9 in the spine). Should I be looking at doing any stem cell treatment at all while I’m still being tested for cancer? My daughter is very skeptical and both my Primary and Orthopedic physicians do not think that I am a good candidate at this time. Do you have a specialist that handles my particular situation that you can recommend?

    1. Larry,
      We wouldn’t consider stem cell therapy in a patient actively undergoing a cancer workup. However, if your foot weakness started after the knee replacements, it’s possible there may be a surgical injury to the nerves that supply those muscles and that this may respond to platelet lysate hydrodisection.

      1. So, are you saying that I could still possibly do the platelet lysate hydrodisection whilst undergoing a cancer workup? Is there a specialist that you can recommend?

  8. In your answer to me (above) you say that “platelet lysate hydrodisection” may help me if I have surgical injury to the nerves; however, in another answer on this forum you told someone “if a nerve has been severed, this will not help”. I’m confused….can you please clarify? Thank you, Larry.

  9. Hi,
    Are you able to treat spinal compression? I got fused from T10 to T12. The compression was due to over weight and bone spurs pressing on my spine. After my surgery, i can’t fully feel my lower part of my body, from waist down. I can control my bowel movements. Right now am doing physio therapy. I can walk but too slow and not really stable, i walk with my crutches or quad cane. I sonetimes use my wheelchair. i can’t feel them. I have trouble bending my right leg and foot. Any way would this treatmemt work for me?

  10. Cervical fusion at c4-c5, c5-c6, c6-c7
    still having neck pain only at 2 years post op, no pain in arms or hands. My pain Dr wants to try PRP in the epidural spaces at the fused levels with the hope of healing any nerve damage/pain . Obviously there is no discs there anymore to try and heal, so it would really be just trying to heal the nerves etc.. in the epidural space. Is this something ya’ll have done in the past and had success with ?

    1. David,
      In adjacent segment disease, meaning the overload of forces affecting the vertebrae above and below the fusion which is inevitable, we use specialized platelet procedures, and in some cases stem cells. Please see: https://www.regenexx.com/pain-after-back-fusion-adjacent-segment-disease/ and https://www.regenexx.com/neck-epidural-failed/ and https://www.regenexx.com/the-regenexx-procedures/back-surgery-alternative/ Ordinary PRP (the type made by machine) tends to be quite inflammatory, and these types of spinal procedures require Fluoroscopy guidance, and a great deal of experience.

  11. Very interesting read. I have been diagnosed with scalp dysesthesia with potential nerve damage. Could this procedure benefit me?

  12. Do ya’ll do cervical PRP injections at your own facility so as where the patient doesn’t have to pay a non insurance covered fee for the use of a separate hospital facility ? If so what are the cost for for the injections themselves , and is that the only fee required ?

    1. David,
      Yes, we do cervical injections with Platelet procedures in the Procedure suites of the Clinics themselves with Fluoroscopy guidance. The exam is covered if your insurance is in network, but for more detail about what else might be covered and price you’d need to call 888 525 3005, 8-5 MST.

  13. Hello,
    I have had foot-drop for many years (over 20), that occurred after ankle reconstruction surgery. In all of these years, I have not been able to find any medical professional that gives me any hope that anything can be done (except AFO).
    I have also not been able to get a proper diagnosis on what exactly is wrong anatomically. I have had EMGs done, but… they all just indicated that there was ‘damage’. That was not very useful. I have been left to guess that something associated with that surgery induced peroneal nerve damage (after doing my own research, finding out that the peroneal nerve is what is behind the dorsiflexion that I can no longer do). I was wondering if any of your therapies can regenerate a damaged peroneal nerve that is an old ‘injury’, such as the one I described. Thank you !

      1. Hello,
        Unfortunately, I do not know. I think the information that was give was very vague, and did not include what exactly was damaged. I believe the terminology that was used was ‘There is significant nerve damage’. At this late point, is this something that I need to do again (hopefully a practitioner that is more suited to my situation than I have had in the past)…. and get the answer to that question ? The EMGs that were done were at different points… all years ago. While I am on the subject… are there tests (be it EMG, or perhaps another more exacting test that is newer??) that can determine the actual location within the peroneal nerve that is damaged, and the length of the damage ? Thank you very much for your prompt reply to my comment. Cathy

  14. Hi there, at the end of 2016 I had surgery for my compartmental syndrome in my lower right leg. Because of the surgery I have significant nerve damage, and I developed foot drop, and I rely upon an AFO for support in my daily activities. I’m wondering if I might be a good candidate for your nerve regeneration procedure???

    1. Amy,
      It would depend on the type of nerve damage. When nerves are inured, entrapped or scarred due to surgery they can become compressed which doesn’t allow the signal to get through, and we can often help with that. Have you had NCS/EMG testing done?

  15. Hi.
    Can this treatment help with ulnar nerve palsy ? My partner got an accidental cut on his elbow and as luck wouls have it, he sustained a nerve cut.. he has had emergency surgery and hand therapies but seems that his hand is now clawing. His hand often goes numb and painful
    Will this procedure help restore his nerves ?

    1. Diane,
      This procedure works well on compressed or injured nerves, but not nerves which have been severed. Has he had any nerve testing done?

  16. According to a neurologist, a neuro surgeon and others who present themselves as neuropathy experts, I have idiopathic peripheral neuropathy. I do not have diabetes, no cancer drugs and no damage due to trauma . Both feet feel numb all the time and the sense of numbness changes throughout the day relative to what I may be doing. It is better or less noticeable when I am walking. There are also varying degrees of burning, stinging, tightness and some of these symptoms are ameliorated by leg and back stretches temporarily. The numbness increases by a factor of roughly five at the moment I get horizontal for sleep. I have tried near infrared therapy, nutritional supplements, chiropractic adjustments and I am currently receiving PRP injections that do not seem to have helped. I have had injections to my feet and along the outside of my legs every other week for the past six weeks. Has your group successfully used PRP or your PL treatment with the neuropathy I describe?
    I am a 70 year old male and I have tolerated the neuropathy for well over 10 years but over the past year the other symptoms I mentioned have occurred .

    1. Syed,
      Peripheral neuropathy can be caused by different things. Drug induced peripheral neuropathy often takes time to resolve after the offending medication has been stopped, though some cases don’t resolve. Are you still taking the medication? What type of medication is thought to have caused this issue?

  17. I have had 3 surgeries on my L5-S1 to relieve sciatica. I was fine after the 2nd one until the bone grew over the sciatic nerve. I had the 3rd surgery to release the nerve and replace hardware. It was quite traumatic. Now I have a damaged sciatic nerve. Could this treatment help?

    1. Darren,

      We have seen some evidence that the growth factors in platelet lysate may be able to help damaged nerves, so our usual treatment for this type of problem is a platelet lysate epidural.

  18. I haven’t been diagnosed yet, but I think I might have nerve entrapment or some nerve damage from cutting my abdominal muscles when I had my gallbladder removed. Can you treat that?

  19. Would this help with a spinal cord injury? L1 incomplete as a result of a fall, July 2015. Emergency decompression surgery with metalwork.

  20. I have foot drop due to a bulged L4 L5 disc about 15 months ago. I had a discecotomy that the surgeon deemed successful within 2 weeks but only regained 50% recovery. Could your treatment help?

    1. It’s possible. I have helped other similar patients. We usually start with a platelet growth factor epidural and hydrodissection of the nerve using precise ultrasound guidance.

  21. I was hoping to try PL around my entrapped illioinguinal and illiohypogastric nerves. I’ve lost most feeling innervated by them. Would giving ultrasound guided PL be an option for me?

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