We’ve been injecting stem cells into back discs for over a dozen years. It’s a very complex procedure that should only be performed by a physician with extensive interventional orthopedic training specifically in disc injections because, though sometimes the appropriate treatment, injecting stem cells into a disc is a riskier procedure than treating other structures of the spine. Despite that, we’ve noticed lately that it seems to be a trend among providers claiming to be experts in the procedure after having only taken a weekend course. Frequently, addressing a disc problem requires more than a disc injection, and while anyone might be a candidate for the weekend-course providers, the important truth is there are times when a disc stem cell injection makes sense, and there are times when it doesn’t.
We’ll explain in a moment, but first let’s review the spine and its surrounding structures.
Understanding the Spine
The spinal column is a complex structure made up of bones (vertebrae), intervertebral discs, joints, nerves, and supporting structures such as muscles and ligaments. We’ll briefly introduce these here, but watch Dr. Centeno’s video below for more detail and images.
Between your vertebrae, which are stacked one atop the other, rests your discs. The discs cushion the spinal bones and absorb shock. The spinal column is made for movement, and as such there are joints that run along the back of the spinal column where each vertebra meets the next—these are called the facet joints. Housed and protected inside the spinal column is the spinal canal, which is a large cable-like bundle of nerves. These spinal nerves exit at the level of each facet joint, one on each side of the spinal column and branch into all peripheral areas of the body. Outside of the spinal column, the multifidus muscle is series of deep muscles that run the length of the spine and provide stability, and there are ligaments that provide additional stability to the spine.
With all of these structures working so closely together, it’s easy to see how a problem in the disc can either affect or be affected by another structure in or around the spine. So when does a disc stem cell injection make sense?
When a Disc Stem Cell Injection Makes Sense
Let’s review a few situations in which a disc stem cell injection makes sense and can certainly be beneficial.
First, a disc tear that is definitely the cause of back pain. This one is usually pretty easy to spot as those who have a painful disc tear experience so much pain they can’t remain in a sitting position for very long. Second, when chemicals are leaking out of a torn disc and onto nearby nerves. When this happens the chemicals can create significant nerve irritation and cause back pain. Watch the video below as our own Dr. Pitts performs a disc stem cell treatment for a disc tear:
Third, we might be able to perform a disc stem cell injection when a spinal nerve becomes compressed by a disc bulge and the issue can’t be managed by epidural platelet lysate injections around the nerve. However, in our experience, treating a disc bulge such as this requires specially cultured stem cells. And while these stem cells are available at our Regenexx licensed advanced cell-culture site in Grand Cayman, they are not available here in Colorado or anywhere in the U.S.
When a Disc Stem Cell Injection Doesn’t Make Sense
There are some common disc issues in which a disc stem cell injection just doesn’t make sense. This is because these disc issues can usually be treated without having to inject the disc directly. One of these issues would be irritated spinal nerves, and the other is a herniated disc. So how do we treat these conditions? We’ve found that healing growth factors precisely injected (our fourth-generation platelet lysate [PL] epidural) using X-ray guidance right around the irritated nerve can treat not only the irritated nerve, but can also manage a disc bulge that is causing the nerve irritation.
It’s important to note, as we mentioned in the opening, more than just the disc or nerve may need to be treated. For example, if the multifidus muscle has atrophied, or shrunk (which can occur when the nerve supply is disrupted), this creates spinal instability and it may need to be treated to address the instability. Likewise, if the ligaments have become lax, the vertebrae can become unstable and slip, so the ligaments may need treatment. If the facet joints have become injured, these may need to be treated. So you can see, treatment isn’t always just about injecting the disc. It requires a whole-spine examination and approach to the problem.
So depending on your disc issue, a stem cell injection may or may not make sense. Disc stem cell injections, performed by a physician appropriately trained and using appropriate guidance, can work very well for the right disc conditions. In addition, it’s important that all of the affected spinal structures are addressed with the appropriate advanced orthobiologic (stem cells, platelet lysate, etc.). Treating the disc but ignoring a loose ligament or irritated nerve isn’t addressing the whole spine problem.