Q. Will stem cells help my spine condition?
A. Stem cells and PRP are being used in spine conditions with good results in some select cases, but it is still very experimental. The evidence that cellular medicine treatments in the spinal disc work for a large population is still at the case series and case report stages. There are no high level controlled studies yet showing this form of treatment works for the multitude of chronic pain patients with damage to their intervertebral disc. With that said, in the last year alone, I witnessed several promising presentations at cellular medicine conferences showing such good evidence that I am offering several different treatment options for my disc patients as a last resort prior to a surgical option. The evidence seems to point to a stepwise approach based on the results of a preliminary diagnostic discogram that will help establish which disc needs treatment. The severity of the disc condition will dictate what the discs need to give pain relief and help the disc heal. For instance, mild injuries can be effectively treated with PRP into the disc, stem cells for more advanced disc injuries, and stem cells with a matrix (such as the patient’s own fibrin glue) for the most severely injured discs.
We do have some options for patients with arthritis in a facet joint and nerves that are irritated by a herniated disc. Traditionally, pain doctors inject high dose steroids around the nerve or into the joints. These only have a temporary effect. Putting PRP into arthritic or injured facet joints and sacral-iliac joints with C-Arm fluoroscopic guidance is helping many of my patients avoid radio frequency ablation, where the nerves to the painful joint have to be burned with high energy every year or so to help them attain pain relief. We can also inject a platelet lysate with a very, very low dose of steroid to help calm the inflamed nerve near a damaged disc with as much pain relief as a high dose steroid shot without the risk of the patient getting too many steroid injections in a calendar year. Early research appears to show a platelet lysate treatment provides the patient with a high dose of the patient’s own growth factors along with a micro dose of steroid that acts as an anti-inflammatory growth factor to help the patient’s painful injured disc or spinal nerve calm down and recover after one to several treatments.
We have nothing yet to offer our end stage spinal stenosis patients other than standard interventional spine treatments and a trial of prolotherapy, which works well for milder disease.
Using cellular medicine injection techniques for spinal conditions is an exciting new frontier in interventional spine medicine that will hopefully make spinal fusion surgery a rare event in medicine.