Back & Lumbar PainStem Cell Treatment

Stem Cell Treatment

For Back & Lumbar Pain

It comes to no surprise to any back pain sufferer that this condition is incredibly hard to treat. This is because of the complexity of the spinal anatomy and function, the complexity of the psychological overlay in pain transmission and perception and also because of lifestyle factors such as exercise, nutrition, and sleep.

The Functional Medicine approach to back pain looks at the lifestyle factors and the relationships between different body systems and pain. It optimizes many of the factors that normally fuel the pain “fire” - inflammation, hormones, digestion, stress, metabolism, energy systems, etc. This is why Functional Medicine is the ideal complimentary approach to Regenerative Medicine, which aims at preparing the body to heal itself.

Why is low back pain so hard to treat? From a purely anatomical perspective, let’s look at a diagram of a typical lumbar segment. The aim of this exercise is not to learn lumbar anatomy, but to perhaps appreciate what your Regenerative Medicine spine physician considers as possible pain sources when you come in the office complaining of lumbar pain.

Click to view full image Every anatomical structure that has nerve endings in it (or is innervated) has the potential to cause pain. From a superficial to a deep level, here are some of the innervated lumbar segmental structures:

Your lumbar pain can originate in any or all of these structures.

  • skin
  • lumbar fascia
  • spinal muscles
  • tendons
  • ligaments
  • bones (vertebrae)
  • lumbar nerves
  • facet joints
  • discs
  • thecal sac coverings

Or it can originate outside of the lumbar area altogether. It could be the result of hip, knee, or ankle dysfunction, or maybe thoracic or cervical spine problems. It is obvious then why most people suffer from back pain for years without good explanations as to where pain is coming from or what to do about it.

At this point, your spine specialist will have several options:

  • 1. He could put you through “a series of three epidurals”, followed maybe by “a series of three facet joint injections”, and maybe by radiofrequency ablation, or, if you are really “lucky”, you might end up with a spinal cord stimulator implant. We will not dignify this approach by even commenting on it. Although long dismissed by research, you would be surprised this is still widely practiced, probably because healthcare insurance still covers it.
  • 2. Alternatively, your spine doctor may opt for a very rigorous diagnostic work-up that will map out most of your pain sources and then he might try to treat each one of these pain sources with traditional conventional methods. We are intimately familiar with this approach, as we have practiced it for years with some good results. There are indisputable advantages to knowing precisely where the pain comes from. Precision Medicine is the future. However, the completion of a rigorous diagnostic work-up requires a motivated doctor and patient, many procedures and office follow-up appointments, and a longer time frame to completion, during which time pain relief may not be achieved.
  • 3. Regenerative Medicine treatment is the newest option for low back pain treatment. Although commonly referred to as stem cell treatments, regenerative treatments also use other regenerative products, such as prolotherapy solution (dextrose solution), platelet-rich plasma (PrP), amniotic fluid/umbilical cord blood/Wharton’s jelly products and exosomes. This option of treatment for low back pain uses some of the diagnostic information obtained from the previous method, but it is a more holistic approach. Think of it as “more is more”. Since the risks of treating more structures than absolutely necessary are minimal to none, we allow ourselves some margin of error in our diagnostic approach when we use stem cells or other regenerative solutions for low back pain. Decreased diagnostic work-up complexity allows for a reduced time until treatment (regenerative treatment).

We hope your Regenerative Medicine spine specialist will chose the third option above every time it is appropriate. But to make it successful, there are several fundamental strategies that need to be implemented throughout this process:

  • 1. Patient selection. Not every patient is a candidate for stem cell treatments. Alignment deformities (scoliosis, kyphosis, spondylolisthesis), spinal instability, severe spinal stenosis with neurological deficits, severe disc degeneration, severe facet joint arthritis, multiple affected spinal segments are all absolute or relative contraindications for regenerative spinal treatments.
  • 2. Precision Medicine diagnosis. This was discussed above. There is also the trade off between how precise should the diagnosis be versus how much time should be spent in delaying treatment at the expense of a rigorous diagnostic work-up.
  • 3. Precise delivery of regenerative solutions into the appropriate structures. We believe strongly that these procedure should not be done without fluoroscopic or ultrasound guidance (or both). The timing go these deliveries is also very important.
  • 4. Optimization of general health. This should be done through an integrative medicine or functional medicine approach. 5. Optimization of physical function. Again, we have several options for fitness and exercise in our office. Without this, prevention of further injury is very hard, if not impossible.

Stem cells are derived from bone marrow or adipose tissue. We have proprietary algorithms for extraction and purification. Once injected in the appropriate anatomical structure, these cells break up and release signaling molecules that direct the existing tissue (cartilage, tendon, ligament, bone) to repair and proliferate.

In conclusion, stem cells (and regenerative solutions in general) could be a good treatment for back pain. Strict rules of patient selection, regenerative cell selection, precise diagnosis and delivery and for a holistic health optimization approach should be applied in order for this treatment to be successful. Defining the success of this treatment is not just in terms of the short term relief of pain but also in terms of prevention of re-occurence.