Are Regenerative Stem Cell Treatments For You?

stem cell therapyOne of the fastest growing fields in orthopedic surgery treatments is in the field of regenerative medicine. Adult stem cells, which can very often be taken from a patient’s own body, are not only safe, but they are also continuously being found to have more and more potential when it comes to pain-relieving treatments.

Sol Kamson, MD, is a huge proponent of regenerative medicine. Dr. Kamson cites a recent research study published in the Journal of Bone and Joint Surgery. The outcome of the study found that knee surgery patients who received stem cell injections into the meniscus about a week following surgery reported less osteoarthritic pain and no complications from the injections.

Though arthroscopic knee surgery is a common procedure, about 25% of patients do not achieve good results, with many put at an increased risk for osteoarthritis post-surgery. Stem cell regenerative treatment after surgery can present a major step forward in combating these risks and outcomes.

The research study reviewed 55 patients who had undergone arthroscopic knee surgery called partial medial menisectomy. All of the patients were divided into three groups, each of which received a different stem cell injection seven to ten days following surgery.

One group’s injection contained 50 million messenger stem cells. These cells help form connective tissue to regenerate the lost knee tissue. Another group received 150 million messenger stem cells, while a third group received an injection containing no messenger stem cells.

The results showed that, over time, the groups who were treated with the stem cells showed some regeneration of tissue with no complications. The more exciting results showed a dramatic improvement in patients’ reports of osteoarthritic pain relief over those in the control group who did not receive stem cells injections.

Though this was a small study with a limited number of subjects, the resulting data shows that regenerative medicine is both safe and quite effective as related to joint pain.

The team at the Spine Institute Northwest understands the power and the potential benefits that regenerative medicine can extend to our patients now and in the future. Call our Bothell, WA office today to discover more about these cutting-edge applications to combat joint pain.

The Management of Back Pain

Recent studies have shown that despite many published guidelines, back pain management varies depending on where you go. Various spinal symptoms and back pain is one of the most common complaints a physician receives. With over 10 percent of visits to a primary care physician being related to the back, the numbers and complaints continue to climb each year. The Harvard Medical School in Boston collected National data and surveys from ambulatory services, hospital facilities, and other medical care facilities. This study was designed to examine the different treatments of back pain from the beginning of 1999 to the end of 2010. Researchers assessed the different types of imaging being used, the use of medications like narcotics and nonsteroidal anti-inflammatory medication, acetaminophen, and referrals for physical therapy.

With treatments for back pain being costly enough, as well as loss in wages from not being able to work, some treatments that aren’t as effective can often times be overused. This can cost even more money with repeated visits for treatments that have little or no effect on the patient. With the collected data, researchers found that close to 24,000 visits to the different medical facilities was because of back and spine problems. Almost 60 percent of the patients were females, and throughout the study period the average patient age increased from 49 years old to 53.

The results of the data were interesting and found that the use of anti-inflammatory drugs and acetaminophen being used at each visit had decreased by 12.4 percent in 2010. The use of narcotics increased by 9.8%, reached just under 30% of patients being treated with narcotics. Throughout the study, referrals for physical therapy remained the same with around 20%. However, physician referrals were found to increase by 7.2%, reaching 14% at the end of the study period. The amount of radiographs held steady at around 17%, while magnetic resonance imaging increased by 4.1% and reached 11.3% for the study period.

Even though there are numerous national guidelines in several different publications, back pain management that is routine increasingly relies on the use of narcotics, diagnostic imaging, and physician referrals. As the costs of healthcare continue to soar and are expected to rise, proper management of back pain can result in not only saving money, but time as well.

A great benefit with minimally invasive surgeries is the affordability of the procedures, and the fact that many patients are able to return to their normal life and work the next day. With proven results in relieving pain, the main goal of the Spine Institute Northwest is to provide the best possible medical care and service to our patients, while focusing on relieving and preventing pain that is often associated with poor pain management. With a commitment to personalized and quality treatment plans for our patients, communication with other health care providers is always important to ensure a team approach so everything that can possibly be done to relieve, prevent, or manage pain is being done.

New Research for Treating Back Pain

A newer research study has suggested that using a type of bio-cellular graft could treat lower back pain. Surgeons have been increasingly using this type of graft to repair tissues that have been damaged. Not everyone in the study that suffered from lower back pain had the same end results. This ranged from receiving complete relief from pain, to no improvement at all.
In this procedure, concentrated forms of the bone marrow are injected into the lumbar discs.

This was in patients that suffer from disc degeneration which usually happens with age as the spinal discs break down. This causes the discs to not be able to absorb as much pressure or impact, and they also become less flexible. Some conservative treatments can fail, and other therapeutic options can be limited for those who suffer from back pain because of degenerative discs. The goal of this procedure is to develop a safe and natural method to help boost the body’s ability in order to heal pain.

The practice of transferring materials within a patient’s own body has continued to evolve further than simply using plasma that is platelet-rich to surround the concentrated cellular bone marrow, and draw cells from the body’s fat. In order to explore the different possibilities with this technique, the research team received data from 22 patients that were treated at the Columbia Interventional Pain Center in Columbia, Missouri. These patients had suffered from lower back pain for an average of 4 years, and have evidence that confirms changes with degenerative discs through MRI’s or CT scans.

The researchers began by harvesting a small amount of iliac bone marrow aspirate, and with the use of a centrifuge obtained the necessary concentrate of bone marrow. This concentrate was then injected into no more than 2 of the annulus of the lumbar disc with the use of a smaller gauged needle. Then it was immediately followed up with a smaller amount of concentrate being injected around the exterior of the annulus.

Between 5-24 months after the treatment, patients had reported different changes in back pain that ranged from feeling complete relief of pain, to no improvement at all. None of the patients had reported the pain worsening, and there were no complications with any of the procedures. Those who did experience relief from pain had also reported a significant improvement in their overall tolerance in activities, or reduced the amount of medication used, or even both.

Continuous research and studies are necessary and important for those who live with constant back and neck pain. As chronic back pain is a common complaint with adults, more and more people are suffering from pain each year, and this is the top reason for missing work each year. This has been a growing concern year after year, and chronic lower back pain has recently been named as the third leading cause of disability-adjusted life years as pain diminishes the overall quality of life.

New Discoveries with Herniated Discs

An award-winning paper published in the health journal Spine has recently raised many questions about just how herniated discs occur. This study that was done by Dr. Rajasekaran and colleagues from the Hanga Hospital in India has been named the winner of the 2013 prize for Lumbar Spine Research through the Society for the Study of the Lumbar Spine.

This study concludes that herniated discs that occur in the lower spine are most often a result of the connecting tissue of the spine and disc separating. Traditionally the cause of herniated discs has always been believed to be caused by the disc rupturing. The results of this study suggest that spinal surgeons should pay more attention to failure with the vertebral end plate junction, and it’s attachment with the discs and spine.

For this study 181 patients were involved who were to have surgery performed due to a herniated lumbar disc. Also known as ruptured discs, this is an all too common cause of lower back pain. The pain is caused when the gel like substance inside the disc leaks out through the tough exterior of the outer disc. The data with these studies included; CT and MRI scans, microscopic studies, x-rays, and surgical observations. Patients that were excluded from this study were those who suffered from a disease that affected multiple discs and patients over 60.

The results for this study found that with 65 percent of the cases, the end plate junction had tore off, also referred to as avulsion. This made avulsion become the most common cause for lumbar disc herniation. These cases found that cartilage and/or a part of the bone that connects the vertebrae to the disc had broken off. Surprisingly with the 181 patients involved, only eleven percent of the cases had the traditional rupture of the outer shell.

Occasionally an avulsion was not able to be seen by x-ray, but it was visible at the time of surgery, and is generally able to be seen with a CT scan. With some cases the avulsion healed itself between the time of the injury to when the surgery was to be performed. However, in some cases narrowing of the spinal canal (known as spinal stenosis), was found to be present. Researchers in this study believe that these failures with an end plate junction have been underrated due to the difficulty of documenting the issues.

In many of these cases there did not seem to be a definite traumatic injury before the herniated disc symptoms appeared, which leads researchers to believe that the process of the herniated disc may take several months to take effect after a fracture. This study has opened the door to develop possible biological and repair strategies, as well as ways to prevent the progression of disc herniation after an initial avulsion. In other words, they may have found a window of time to use some sort of treatment to possibly prevent any more damage being done to the discs.

The Use of Nerve Mapping Technology

New studies and research in the medical field are always being conducted to advance technology, improve diagnosis, treatments, and the healing process. A newer tool that is known as Nerve Mapping Technology is proving to be successful and beneficial. This technology will allow a surgeon to determine if a surgery that has been performed to relieve pressure from compressed nerves is effective or not. These compressed nerves are what generate weakness and pain in the muscles through the nerve. This technique of nerve mapping allows the patients nerves to be located and traced for nerve blocks during procedures like regional anesthesia. Nerve mapping allows anesthesiologist to better determine the best area to insert the needle, prior to beginning the procedure.

A small study at the Henry Ford Hospital involved 42 patients to determine the effectiveness of mechanomyography (MMG) technology when measuring nerve functions, and determining whether or not the nerves are compressed. This technique detects the movement of muscles, and sends real time data and alerts to the surgeon. By measuring the nerves during a surgery, it helps eliminate risks that may require additional surgeries. In the past, patients who were operated on with nerve decompression, doctors wouldn’t know if it was successful until after the patient had recovered. This will allow them to differentiate between the sizes of the nerves, and the severity of compression.

It is estimated that 8 out of 10 people are affected by back pain at some point in their lifetime. Over a quarter of adults in the U.S. have reported having back pain for at least a day within the last three months, and with patients realizing the many benefits of minimally invasive surgeries, these types of procedures are quickly on the rise. This will be an effective tool for monitoring nerve function throughout the surgery. This nerve mapping technique can be used in the upper limb with the musculo-cutaneous, brachial plexus, axillary, median, ulnar, and also radial nerve blocks. In the lower limb it is effective with the; sciatica, popliteal, and femoral nerve block. This tool will also be particularly useful for patients when anatomical marks are gone, or difficult to detect because of contractures, burns, or major limb defects.

In the study at Henry Ford Hospital with 42 patients, researchers tested the threshold of stimulation with 64 nerves. They achieved this with direct contact before and after the decompression. This includes removing a small portion of the bone that is over the nerve root so it is able to heal without any complications. Prior to the decompression, 89 percent of the nerves in the study had an elevated threshold that was higher than normal. After decompression, the median threshold was substantially lower, and 70 percent of the nerves had a threshold that was normal. This new technology will allow surgeons to make quicker and better decisions during the operation because improved testing of the nerves during the operation should result in a quicker recovery time and better outcomes.

The SMART Clinical Study

Each year the number of people who suffer from lower back pain continues to grow. As technology advances and new studies are performed, newer procedures are continuously being developed to help find the causes of pain, and how to better treat them. A new clinical trial is underway that will investigate a minimally invasive procedure for treating lower back pain. Referred to as the SMART Clinical Study, the study will be evaluating what is called the Intracept Procedure.

Clinical trials are very important because they test not only the safety, but the efficacy of medical devices, procedures, and drugs, before they are made available to the public. Patients that volunteer for this study must meet certain criteria, and go through continuous testing and evaluations. The ultimate goal is to determine if the new treatment provides more relief from pain than the current treatments that are available.

There are many different types of back pain, and Axial lower back pain is one of the most common type. This is the type of pain that worsens with particular activities like sports, or positions like sitting for extended periods of time. Unlike many other types of lower back pain, axial pain doesn’t travel through the body to other places like the hips, legs, or feet. It remains confined to a particular area in the lower back. With the many causes of back pain, the basivertebral nerve plays a big factor with the pain. This is a nerve that senses pain, and is embedded inside the vertebrae. It extends to the bone’s surface, and regular movements can cause irritation to the nerve, which results in severe pain. Those who suffer from this severe lower back pain can often be withdrawn from activities and have a poor outlook on life, as they live in constant pain.

This type of procedure generally takes around an hour, as the surgeon goes through a small incision of about two centimeters. A probe is then inserted to the vertebrae, and is carefully positioned in the exact area of the basivertebral nerve that is producing the pain. Once it is in place, with the use of radio frequency energy the probe then disables the nerve so then it is not able to transmit anymore pain signals. If the study results in effective treatment, this could offer another minimally invasive procedure to help relieve many of the symptoms that are associated with chronic lower back pain.

The privately held Relievant Medsystems Inc., is a developer of medical devices for therapeutic purposes with nerve ablation for treating chronic lower back pain. They announced in April 2013 that they had received approval from the Food and Drug Administration to continue on with the SMART Clinical trials. They were also granted an expansion on the number of trial centers they were allowed, and may now have up to twenty. There are currently twelve different study locations throughout the United States that are participating in this study. After the procedure, the patients are evaluated for at least a year, so it will be interesting to hear the results of this potentially promising new treatment.