How to Treat the Spine with Stem Cells
Harvested adult adipose derived stem cells are injected into the spine under fluoroscopic guidance, utilizing local anesthesia. Once inside, the stem cells have the ability to repair the cartilage in a number of ways.
Stem cells secrete various soluble factors which alter the tissue microenvironment such as:
- Cytokines which control joint inflammation.
- Growth factors which stimulate cartilage repair.
Stem cells can proliferate and differentiate into cartilage cell lines.
Degenerative Disc Disease
Degeneration of one or more of the intervertebral discs of the spine is referred to as degenerative disc disease, or degenerative disc disorder. This is a pathologic process that may cause acute or chronic low back pain or neck pain. The typical radiographic findings in degenerative disc disease are black discs, disc space narrowing, vacuum disc, endplate sclerosis, and osteophyte formation. Degenerative disc disease can greatly affect the sufferer’s quality of life.
With symptomatic degenerative disc disease, chronic low back pain sometimes radiates to the hips, where there is pain in the buttocks or thighs while walking. Additionally, occasional complaints of sporadic tingling or weakness to the knees hands or fingers may be evident.
After an injury, some disc become painful because of inflammation and the pain comes and goes. The development of degenerative disc disease can lead to chronic debilitating pain, which has a serious negative impact on individual’s quality of life. When pain from degenerative disc disease is severe, traditional nonoperative treatment may be ineffective.
Facet Joint Syndrome
Facet joint syndrome is a syndrome in which the facet joints (synovial joints which are present from the second cervical vertebra to the S1 vertebra of the low back) result in spinal pain. Approximately 55% of facet syndrome cases occur in the cervical vertebra, and 31% in the lumbar vertebra. Facet syndrome can progress to spinal osteoarthritis, which is known as spondylosis. The facet joints are formed by the superior and inferior processes of each vertebrae. In the lumbar spine, facets provide about 20% of the twisting stability in the low back. Each facet joint is positioned at each level of the spine to provide the needed support especially with rotation. The facet joints also prevent each vertebra from slipping over the one below.
A small capsule surrounds each facet joint providing lubrication and nutrition to this true joint. The joint also has a generous supply of tiny nerve fibers that provide pain stimulus when the joint is injured or irritated. Inflamed or irritated facet joints can cause powerful muscle spasm and pain.
Facet joint symptoms primarily manifest themselves in the lumbar spine, since the strain is highest here due to the overlying body weight and strong mobility requirements. Affected individuals usually feel dull pain in the cervical or lumbar spine that can radiate into the buttocks and legs. Typically, the pain is aggravated by stress placed upon the facet joints by extension of the back, or lateral bend to the right or left. Activities, including prolonged standing or walking, can instigate these types of increased stresses.
Sacroiliac Joint Pain
Sacroiliac joint dysfunction or sacroiliac joint syndrome generally refers to pain in the sacroiliac joint region, caused by abnormal motion of the sacroiliac joint, exhibiting either too much motion or too little motion. This typically results in inflammation of the sacroiliac joint and can be debilitating.
The sacroiliac joint is a true diarthrodial joint that joins the sacrum to the pelvis.
The sacrum connects on the right and left sides to each of the pelvic bones to form the sacroiliac joints. The sacroiliac joint moves with walking and movements of the torso. Studies have documented that motion does occur at the joint, therefore, slightly subluxed and even locked positions of this joint can occur. Muscles and ligaments surround and attach to the sacroiliac joint in the front and back. These can all be a source of pain and inflammation if the sacroiliac joint is dysfunctional.
Common symptoms of sacroiliac join dysfunction include lower back pain, buttock pain, sciatic leg pain, groin pain, and hip pain. Pain can range from dull aching to sharp and stabbing, and it increases with physical activity. These symptoms worsen with prolonged or sustained positions, such as prolonged sitting, prolonged standing, and prolonged lying. Bending forward, stairclimbing, hill climbing, and rising from a seated position can also provoke pain. Pain has even been reported to increase during menstruation in women. Patient with sacroiliac joint dysfunction can also develop tightness and dysfunction in the hamstring, quadriceps, iliotibial tract, and hip flexors.
As many as 58% of patients diagnosed with sacroiliac joint pain had some inciting traumatic injury, based on clinical examination findings.
Injury to the ligaments that hold the sacroiliac joint is thought to occur as a result of a torsional high-impact injury (such as automobile accident), or a hard fall resulting in hypermobility. Hormone imbalances, particularly those associated with pregnancy, and the hormone relaxin can also cause ligamentous laxity resulting in weakening of the sacroiliac joint structures. Women who have delivered large babies, or who have had extended labors also are prone to developing chronic sacroiliac joint pain and instability.
Routine diagnostic testing, such as x-ray, CT scan, or MRI do not usually reveal abnormalities within the SI joints, therefore cannot reliably be utilized for diagnosis of sacroiliac joint dysfunction. There is a new definitive imaging test SPEC/CT, which can sometimes detect sacroiliac joint dysfunction.
The current “gold standard” for diagnosis of sacroiliac joint dysfunction emanating within the joint itself is sacroiliac joint injection confirmed under fluoroscopy or CT guidance injection using a local anesthetic solution. The diagnosis is confirmed when the patient reports significant relief of pain from the diagnostic injections performed on two separate visits.
An intervertebral disc disorder is a common condition that involves either deterioration, disc herniation, or other dysfunction of an intervertebral disc. As people age, the nucleus pulposus begins to dehydrate, which limits its ability to transfer and distribute loads between the vertebra. Pain due to inability of the dehydrating nucleus pulposus to absorb shock is called axial pain or disc space pain.
Disc herniation is a medical condition affecting the spine in which a tear in the outer ring of the intervertebral disc allows the soft central portion of the disc to protrude out beyond the damaged outer rings. This tear in the disc ring may also result in the release of inflammatory chemical mediators, which directly cause severe pain even in the absence of nerve root compression.
Most minor disc herniations heal within several weeks. Severe herniations may not heal on their own, and may require surgery.
Symptoms of a herniated disc can vary depending on the location of the herniation, and the types of tissue that become involved. Symptoms can range from minimal pain, if the disc is the only injured tissue, to severe unrelenting neck or lower back pain that can radiate into the regions served by the affected nerve roots that are both irritated and impinged by the herniated material. Disc herniations can result from general wear and tear, such as when performing jobs that require constant sitting and squatting, or driving. However, disc herniations most often result from jobs that require lifting.
There is now recognition of the importance of “chemical radiculitis” in the generation of back pain. It is increasingly recognized that back pain rather than being solely due to compression, may also be due to chemical inflammation. There is evidence that points to a specific inflammatory mediator of this pain called tumor necrosis factor alpha (TNF α). This chemical is released not only by the herniated disc, but also in cases of annular disk tear, facet joint injuries, and spinal stenosis.
Diagnosis of disc injury is made by history, physical exam, as well as x-ray and diagnostic imaging studies, including Magnetic Resonance Imaging or Computed Tomography (CT scan).