Identify The Source Of Pain
Ideal Candidates for lumbar stem cell treatment include those with discogenic (pain derived from the lumbar disc) low back pain that has failed conservative treatment. Low back pain can come from multiple sources in the spine. These include muscle, ligaments, lumbar facet joints, and vertebral discs in your low back. The most accessible areas to treat are the muscles, ligaments, and facet joints. These treatments can include activity modification, over the counter medications, physical therapy, chiropractic care, and spinal injections.
Diagnostic Testing To Confirm The Disc Is Causing The Pain
Very often, I will recommend lumbar facet injections and/or medial branch blocks, and if patients respond with immediate relief, I will perform an endoscopic rhizotomy to treat the back pain derived from the facet joints. However, if these treatments are ineffective, the likely source of the pain is the disc. If the pain is determined to be from the lumbar disc (discogenic), one could consider an epidural steroid injection. However, usually, the relief with an epidural injection for discogenic low back pain is temporary. If that injection does not help, then surgery is what we usually must provide. Sometimes a test called a discogram is used to confirm the source of the pain as the disc.
Traditional Spine Surgery Option
For many years, minimally invasive spine fusion or stopping the motion of a disc was the only option. This spine fusion is usually performed with screws and rods as well as cadaver bone to bridge a fusion/union between two vertebral bones in your spine. Minimally Invasive spine fusion has been known to be successful at decreasing back pain by about 50% when the known location of the pain is well defined. However, fusions have a lot of risks and lengthy recovery associated with them. Generally, spinal fusion requires screws and rods, at a minimum overnight hospital stay, and up to one year of total recovery. Most patients are out of work at least six weeks after minimally invasive spine fusion. If their job is physically demanding, then they will most likely be out of work for at least three months.
Spine Fusion Can Lead To Future Surgery
The other issue with minimally invasive spine fusion is that after stopping the motion of that affected disc, there is an increase of stress on the discs above and below that level. We know that this leads to “adjacent level surgery” at a rate of 3% per year. As a result, more than half of the people will have surgery on their spine at a disc above or below their prior fusion within twenty years. For this reason, artificial disc replacement (ADR) has been developed.
Artificial Disc Replacement – Motion Preservation
With ADR, we remove the painful disc and replace it with a moving implant made of metal and plastic (similar to hip and knee replacement surgery in orthopedics). The limitations of artificial disc replacement are that it does not address the pain from the facet joint on the back of the spine. Disc replacements have been studied extensively, and the literature shows that 85% of patients improved after artificial disc replacement (in appropriately selected patients). The reduction of low back pain is generally about 50%. Again, this requires extensive surgery with an approach to the spine through your abdomen in which it puts the large blood vessels at risk. Also, this generally requires an overnight stay in the hospital and recovery from anywhere from six weeks to one year.
Costly Surgery And Loss of Wages
Both fusion and artificial disc replacement require post-operative physical therapy as well. Both of these have a very high cost because of spinal implants and hospital stays. Also, there is a significant loss of wages when not being able to work for several months. Because of the surgical risks, costs, and extended recovery of these surgeries we have been searching for better options. Over the past few decades, there has been an increase in research on the use of stem cells to help the pain derived from injured or degenerative discs.
Stem Cell Therapy – A New Frontier
A few years ago, a study following the results of injecting concentrated bone marrow isolating the stem cells from the pelvis, into a damaged disc (in place of spinal fusion or ADR) showed excellent results at two years after this procedure. This study showed that 80% of patients avoided invasive surgery up to two years after this procedure. Also, pain and function improved by 60-70% percent. We now offer stem cell treatments for a degenerative spinal disc at the International Spine Institute in the correct patient. This procedure can be done awake, in the office, and with post-procedural pain generally limited to one week after the procedure. In other words, patients can get this procedure done for damaged disc and be back to work in as little as one week.
Ideal Stem Cell Candidate For Low Back Pain
There are specific criteria that need to be met these include:
- Patients without significant pain from the facet joints
- No considerable instability of the spine
- No significant shooting pain in the legs or radiculopathy
- No extrusion of disc material, and mild to moderate degeneration (usually less than 50% loss of disc height).
The goal of this procedure is to decrease pain. The way this decreases pain is likely due to a combination of multiple things including reducing inflammation, promoting scarring or healing of the disc/tears of the disc, and potentially increasing the fluid or hydration of the disc.
Advantages of Stem Cell Therapy
- Least Invasive Procedure – an outpatient procedure using a local anesthetic, takes about 2 hours and requires no pain medication after the procedure
- No Risk of Rejection – autologous (your own stem cells) stem cells are harvested from your bone marrow and reintroduced to your spinal disc.
- Avoiding Spine Surgery – using stem cell therapy can help patients delay or prevent spine fusion.
- Regenerate Your Damaged Spinal Disc
- No Significant Loss of Work – the procedure does not require a lengthy recovery like spine surgery would
- No General Anesthesia Needed – mild oral or IV medication can be used and local anesthesia to the skin
- Significant Pain Reduction
- Increased Mobility
Before you undergo a minimally invasive spine surgery or fusion for low back pain, I encourage you to ask questions to better understand your doctor’s treatment plan. If you have been recommended for spinal fusion to treat your low back pain, our team may be able to help you. Contact our staff at International Spine Institute to get a free review of your MRI* and learn more about our least invasive spine procedures.
* The MRI Review is an informational review of the MRI images and report that you provide to us and is not a form of diagnosis. A diagnosis and final treatment plan for which you may benefit from at International Spine Institute can only be made after Dr. Rodriguez performs a physical examination at one of our offices in Louisiana. The Free MRI Review has no value and will not be billed.