PRP For Cervical Anterior Longitudinal Ligament (ALL) Injuries

Repair of damaged ALLs is possible with this new PRP treatment. Platelet-rich plasma (or PRP) is made by taking your own blood, centrifuging (or spinning) it to separate the components and concentrating the platelets. The concentrated platelets can then be injected under ultrasound and X-ray guidance into the areas of the ALL injury. 

Platelets have growth factors, cytokines, proteins, exosomes, and more that mediate that healing response. PRP can be used to treat mild to moderate ALL injuries.

What Is The Cervical Anterior Longitudinal Ligament?

The anterior longitudinal ligament is a thick band of tissue that covers the bones and disks along the anterior (front) of the spine. It runs from the cervical spine (neck) down to the sacrum (tailbone).

It helps to stabilize the front of the spine and confines and supports the intervertebral discs. (Intervertebral discs are cushions of cartilage between the vertebrae in the spinal column.) 

The function of the ALL is to prevent hyperextension to reduce excess stress on the back (posterior aspect) of the disk and facet joints in the neck. The most common cause of ALL injuries is hyperextension from whiplash injuries. Whiplash is a neck injury due to a forceful, rapid back-and-forth whipping motion of the head and neck, such as might be sustained in a car accident.  

The back motion typically injures the ALL, while the front motion can injure any of the many ligaments at the back of the neck. The ALL band near the C5-6 vertebrae is the most susceptible to injury.

Different Cervical Anterior Ligament Injuries

The neck ALL can be injured at any level of the spine. Injuries can be classified by degree of damage, as follows: 

• Grade 1 ALL injuries occur when the ligament is mildly stretched or there are very small tears. These injuries often at least partially heal on their own but many times there is just partial healing. 
• Grade 2 ALL injuries occur when there is partial tearing of the ligament, but it is not completely torn. These injuries typically do not heal well on their own and lead to chronic instability and symptoms over time. 
• Grade 3 ALL injuries occur when there is a complete tear across the entire ALL. These injuries are rare and if they do occur, they do not heal on their own and sometimes require surgery if the instability is too severe.

Platelet-Rich Plasma (PRP) Injections As Cervical ALL Injury Treatment

Platelet rich plasma or PRP can be used to help many orthopedic tissues heal, including the ALL. PRP is made by taking blood from a patient’s arm, then concentrating the platelets out of the blood by spinning it to separate its components. We then remove the components not desired, such as red and white blood cells, and isolate the platelets.

This all can be done by an automated machine that makes one specific PRP product. At the Centeno Schultz Clinic and all Regenexx providers, this processing is conducted in a lab, by hand, by lab techs. Using this method we can make purer, more concentrated, and more variety of PRP products, based on the patient’s exact needs.

PRP can then be injected into the ALL to initiate healing in the ligaments. This can help to heal Grade 1-2 ALL sprains, which are the majority of ALL injuries. 

How PRP Relieves Pain In The Cervical ALL

PRP contains many growth factors, proteins, exosomes, etc that help initiate a healing response in tissues. It acts as an espresso shot, stimulating the local cells to work harder to repair damaged tissues. PRP has to be placed directly into the area of damage to have the biggest effect, as it will not magically migrate to other areas. 

We would inject the ALL directly to improve the ALL function and help with pain from the ALL. In addition, strengthening the ALL as well as other injured ligaments of the neck (which we would inject in the same treatment) would in turn take stress off the neck and reduce pain. More neck stability would also allow tight and painful muscles to relax.

If other structures such as the facet joints, nerves, and/or disks were damaged along with the ALL, we would inject those as well to provide healing, structural support, reduce inflammation, and provide pain relief. This is called the functional spinal unit (FSU) approach.

This approach provides more benefit than treating just one or two structures that may be causing pain while ignoring other contributors of not just pain but neck function. You may read further about this in our research paper here.

Introducing The PALL Procedure By Dr Pitts

Here at the Centeno-Schultz Clinic, Dr Pitts pioneered and refined injecting the ALL ligament. This is such a complex procedure that 99% of doctors are reluctant to attempt it.

Dr. Pitts developed a technique called the percutaneous treatment of the anterior longitudinal ligament (PALL), which means treatment of the ALL through the skin, utilizing ultrasound and fluoroscopy in combination, to safely inject the C2-T1 area ALL ligaments.

To successfully perform these injections, an intimate working knowledge of the spinal anatomy is required, along with years of X-ray and ultrasound guided injection experience. Care must be taken to avoid important structures such as nearby arteries, veins, and nerves in the front of the neck as well as the thyroid, larynx and esophagus.

We use contrast confirmation under fluoroscopy to ensure accurate placement of the PRP. This is a complex, highly skilled injection that your family doctor, orthopedic surgeon, or traditional pain doctor cannot perform. 

Experience Relief From Pain Related To Cervical ALL Injuries

You do not have to live with chronic neck pain due to ALL injuries. At the Centeno-Schultz Clinic, we have pioneered the specialized PALL procedure to help reduce pain and discomfort related to cervical ALL Injuries.

Christopher J. Centeno, MD

Christopher J. Centeno, M.D. is an international expert and specialist in Interventional Orthopedics and the clinical use of bone marrow concentrate in orthopedics. He is board-certified in physical medicine and rehabilitation with a subspecialty of pain medicine through The American Board of Physical Medicine and Rehabilitation. Dr. Centeno is one of the few physicians in the world with extensive experience in the culture expansion of and clinical use of adult bone marrow concentrate to treat orthopedic injuries. His clinic incorporates a variety of revolutionary pain management techniques to bring its broad patient base relief and results. Dr. Centeno treats patients from all over the US who…

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John Schultz, MD

John R. Schultz M.D. is a national expert and specialist in Interventional Orthopedics and the clinical use of bone marrow concentrate for orthopedic injuries. He is board certified in Anesthesiology and Pain Medicine and underwent fellowship training in both. Dr. Schultz has extensive experience with same day as well as culture expanded bone marrow concentrate and sees patients at the CSC Broomfield, Colorado Clinic, as well the Regenexx Clinic in Grand Cayman. Dr. Schultz emphasis is on the evaluation and treatment of thoracic and cervical disc, facet, nerve, and ligament injuries including the non-surgical treatment of Craniocervical instability (CCI). Dr. Schultz trained at George Washington School of…

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John Pitts, M.D.

Dr. Pitts is originally from Chicago, IL but is a medical graduate of Vanderbilt School of Medicine in Nashville, TN. After Vanderbilt, he completed a residency in Physical Medicine and Rehabilitation (PM&R) at Emory University in Atlanta, GA. The focus of PM&R is the restoration of function and quality of life. In residency, he gained much experience in musculoskeletal medicine, rehabilitation, spine, and sports medicine along with some regenerative medicine. He also gained significant experience in fluoroscopically guided spinal procedures and peripheral injections. However, Dr. Pitts wanted to broaden his skills and treatment options beyond the current typical standards of care.

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Jason Markle, D.O.

Post-residency, Dr. Markle was selected to the Interventional Orthopedic Fellowship program at the Centeno-Schultz Clinic. During his fellowship, he gained significant experience in the new field of Interventional Orthopedics and regenerative medicine, honing his skills in advanced injection techniques into the spine and joints treating patients with autologous, bone marrow concentrate and platelet solutions. Dr. Markle then accepted a full-time attending physician position at the Centeno-Schultz Clinic, where he both treats patients and trains Interventional Orthopedics fellows. Dr. Markle is an active member of the Interventional Orthopedic Foundation and serves as a course instructor, where he trains physicians from around the world.

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Brandon T. Money, D.O., M.S.

Dr. Money is an Indiana native who now proudly calls Colorado home. He attended medical school at Kansas City University and then returned to Indiana to complete a Physical Medicine and Rehabilitation residency program at Indiana University, where he was trained on non-surgical methods to improve health and function as well as rehabilitative care following trauma, stroke, spinal cord injury, brain injury, etc. Dr. Money has been following the ideology behind Centeno-Schultz Clinic and Regenexx since he was in medical school, as he believed there had to be a better way to care for patients than the status quo. The human body has incredible healing capabilities…

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