Treating Spinal Discs with Regenerative Medicine at Integrative Rehab Medicine
Non-surgical, minimally invasive injections of orthobiologics can improve disc health and restore spinal function
What are the spinal discs and what is their function?
The spinal discs are rubbery structures between each vertebrae of the spinal column. They act as shock absorbers and allow for spinal movement. Spinal discs have a thick outer ring made of fibrous cartilage and a gelatinous inner core known as the nucleus pulposus. Injuries and wear and tear of the spine can cause spinal discs to degenerate, dry out and loose height. The outer fibrous ring can develop tears that allow the gelatin nucleus to leak out. This causes severe inflammation in the nearby spinal structures leading to pain and muscles spasms. The spinal nerves can become compressed or inflamed, causing pain, numbness or weakness of the extremities. The health of the spinal discs dependents on the health and stability of the surrounding joints, ligaments and muscles of the spinal unit. If these structures are weak, damaged or unstable, excessive forces are exerted on the disc causing it to degenerate and become symptomatic.
How can degenerated discs be treated with Regenerative Medicine?
Regenerative Medicine injections (with PRP and Bone Marrow Stem Cells) into the discs and surrounding spinal structure are an effective way decrease pain and restore health and function of the spine. PRP stands for Platelet Rich Plasma, a solution of highly concentrated platelets made from the patient’s own blood. The platelets are packed with growth factors that initiate healing and decrease pain and inflammation. Bone Marrow Stem Cells are highly specialized healing cells that sense the environment and orchestrate the healing process. Both of these products are completely natural, taken from the patient’s own body and injected back into the spine to stimulate healing and regeneration. An array of research studies have proven that they are safe and effective at treating the spine and providing long term results.
A study by Dr. Lutz, published in 2022, showed that an injection of very highly concentrated PRP (greater than 10x) into the spinal discs provided 50% improvement in pain relief and function even at up to 18 month follow up. In this study, 81% of patients were satisfied with the treatment. High concentration PRP injections showed much better result than lower concentration PRP (Lutz 2022). At integrative Rehab Medicine, we only use high concentration PRP of ~ 13-15X baseline for any of our disc injections.
In a study published in 2017, Dr. Pettine treated 26 patients with moderate to severe lumbar disc degeneration who were considered candidates for lumbar fusion or disc replacement surgery. He demonstrated that an injection of bone marrow stem cells significantly decreased the pain and improved function all the way up to 3 year follow in 20 of the 26 patients (77% responders). Their pain decreased on an average from 8.2/10 to 2.2/10 (73% improvement) and their functional scores improved ~ 70%. Only 6 patients proceeded to surgery within the 3 year study time frame. Many patients also demonstrated an improvement of the disc appearance on MRI images taken 1 year after injection (Pettine 2017).
Many studies have shown that both PRP and bone marrow stem cell injections into the spinal facet joints, SI joints and muscles are safe and effective at treating pain and dysfunction. PRP has also been shown to be effective in the epidural space and around nerves in patient with disc herniations and sciatica.
Spinal lumbar disc treatments at Integrative Rehab Medicine
At Integrative Rehab Medicine, we treat the spine as an integrated unit. Dr. Sebastian uses PRP and Bone Marrow stem cells to inject into discs, the supporting structures and around the nerves. This comprehensive approach provides the best results to restore health and function of the spine as a whole. Dr. Sebastian uses advanced imaging such as ultrasound and X-ray to precisely inject highly concentrated PRP and bone marrow stem cells into important structures. He also uses other components of the plasma to help seal any tears in the outer ring of the disc, stimulate growth of the muscles that support the spine and decrease inflammation of the spinal nerves.
Every measure is taken to decrease any risks and assure patient safety. The orthobiologic processing is performed under a sterile hood and the procedure is performed with strict sterile technique. Advance image guidance is used for all the injections to assure safety and accuracy. To decrease risks of disc infections, the patient receives IV antibiotics (Cefazolin) prior to the procedure as well as a small dose of antibiotics into the disc (gantamicin) at the time of contrast injection.
The injection area is cleaned with surgical grade antiseptics and anesthetized with lidocaine and other analgesics before the procedure. Patients often use nitrous oxide (laughing gas) to make the procedure more comfortable. During the injection procedure, Dr. Sebastian communicates with the patient on the progress of the procedure. After the procedure, the area is cleaned and a red and blue laser light is applied to further stimulate healing. After the laser treatment, the area is covered with sterile dressings and the patient is discharged home.
Several days of pain, soreness and muscles guarding are expected after the procedure, therefore the patient is sent home with pain medications. A lumbar brace is used for four week after the procedure to help protect the spine. The patient is instructed to gradually increase walking but to avoid any lumbar flexion and lifting a four week period. Gentle physical therapy is started one week after the procedure.
Some References:
Pettine, Kenneth A., et al. “Autologous bone marrow concentrate intradiscal injection for the treatment of degenerative disc disease with three-year follow-up.” International orthopaedics 41 (2017): 2097-2103
Lutz, Cole, et al. “Clinical outcomes following intradiscal injections of higher-concentration platelet-rich plasma in patients with chronic lumbar discogenic pain.” International Orthopaedics 46.6 (2022): 1381-1385
