The human spine is composed of 24 individual bones called the vertebrae. In between these bones are the intervertebral discs, which are gel filled structures that act as shock absorbers. They consist of a tough outer layer called the annulus fibrosus that protects the disc’s gel-like interior, the nucleus pulposus. In the lower back, the discs are a little more than a third of an inch (10 millimeters) thick and about 1.5 inches (four centimeters) in diameter.[i]
A bulging disc or herniated disc occurs when the outer layer of the disc weakens and tears. This can cause the inner gel to bulge out to the spinal canal and affect the nearby nerves causing back pain, leg pain or muscle spasm. The disc tear can also cause leakage of materials into the spinal canal that can cause inflammation and pain.
Herniated discs most often occur in the lower back but can occur anywhere in the spine, including the neck and the midback. The location of the herniated disc often determines where the patient will feel symptoms of pain, tingling, numbness or weakness. Bulging discs in the lumbar spine can result in pain in the low back, buttocks, thighs, legs and feet. On the other hand, if your herniated disc is in the cervical spine, pain can be felt in the neck, shoulders, arms and hands.
What Causes a Herniated Disc?
Disc herniation can occur due to injury or age-related wear and tear. As people age, the disc nucleus pulposus loses hydration, wears down and leads to degeneration. Other factors may increase the risk of developing a herniated disc. These include:
- Repetitive lifting, pulling, pushing, bending and twisting
- Increased height (tall people)
- Smoking (decreases blood supply to the disk leading to degeneration)
A thorough medical history and physical examination can lead to the diagnoses of disc herniation. An MRI of the spine is an imaging modality that reveals herniated discs and other structural abnormalities of the spine.
The treatment for most cases of mild to moderate herniated discs involves conservative measures which include the following:
- Activity modification: Avoid repetitive twisting, bending or lifting. Do not sit or stand for extended periods of time.
- Physical therapy to strengthen your trunk, arm and leg muscles that support the spine.
- Medications: Anti-inflammatory medications such as ibuprofen or naproxen, muscle relaxers, or pain killers
- Ice packs or heating pads
- Alternative therapies such as acupuncture, massage or gentle chiropractic manual therapies to manage pain.
When conservative measures fail to provide symptomatic relief, a board-certified spine specialist can offer injection treatments that do not require hospitalization and provide a more rapid recovery than surgery.
Epidural corticosteroid injection is a treatment that delivers steroid, a powerful anti-inflammatory medication, directly to the source of pain. This is performed using fluoroscopic (x-ray) guidance. This treatment can provide immediate relief of pain. The number of treatments is limited as repetitive steroid use could result to tissue damage, hormonal irregularities, osteoporosis and decreased immune response.
Cell-based therapies can treat disc degeneration and tears that are traditionally managed with medications or surgery. These treatments have been shown to increase disc hydration and disc cell proliferation, decrease inflammation, increase disc support tissue and assist in tissue healing. These therapies involve obtaining the patient’s own healthy cells and delivering them to the injured disc where they can jump start the body’s own regenerative healing processes.
- Platelet Rich Plasma uses platelets in the blood that release growth factors and proteins to promote tissue repair, while the plasma carries the hormones, electrolytes and nutrients required to nourish cells during the healing process.
- Cell Based Therapies use cells derived from the patient’s own bone marrow. Bone marrow contain adult stem cells that have the unique ability to develop into the specific kind of cells, including anulus and nucleus pulposus cells. They also contain many other healing cells and molecules that direct other cells in the area to form new blood vessels, awaken stem cells and produce collagen or other proteins essential for creating healthy new tissue.
Patients considering regenerative treatments such as these cell therapies need to know that the U.S. Food and Drug Administration (FDA) does not currently allow the use of stem cells derived from birth tissue products such as amniotic fluid or umbilical cord blood to treat orthopedic conditions. These donor products do not contain live stem cells and have not been tested for safety or efficacy.
Candidates for Cell-Based Therapies for Herniated Discs
The success of cell-based treatments for herniated discs is dependent upon the severity of your condition and your overall health. Cell-based treatments are not suitable for those who have active cancer, infection, history of blood disease, or are pregnant.
Cell-based therapies are giving new hope for long-lasting pain relief to many patients with injured discs. It is important that you take an active role in your healing and recovery with good nutrition and a commitment to overall fitness to achieve the best outcome.
Drs. Christopher J. Rogers and Mary A. Ambach of San Diego Orthobiologics Medical Group together have successfully treated thousands of patients with interventional spine procedures and cell-based treatments for more than three decades. They are published authors and cell therapy researchers. Their facility in Carlsbad contains the most advanced Regenerative Medicine technology in San Diego and offers same- day treatments with the highest level of safety and efficacy.
Whether as a result of injury or age related wear-and-tear, pain in the neck can be more than just a saying: it can be debilitating.
According to the Mayo Clinic, neck pain is the fourth leading cause of disability in the United States. Most episodes of acute neck pain will resolve without treatment, but almost half of the people with neck pain will suffer from recurrent episodes.[i] The good news for these patients is that science and technology are working together to help physicians identify the source of neck pain and offer new options for long-lasting relief.
Identifying the Source of Neck Pain
Advancements in imaging have allowed physicians to get a better look at the intricate details of the spine. This enables them to see the different structures in the cervical spine (neck) more clearly and can help them identify the source of chronic, unresolved neck pain.
Common sources of chronic neck pain include the following:
- Arthritis: Osteoarthritis of the spine can lead to degeneration that is associated with the normal wear and tear of joints, discs and bones in the spine as people age. The arthritis can lead to bone spurs that can make movement of the neck painful and create narrowing of the space around the spinal nerves and spinal cord; a condition called spinal stenosis.
- Cervical Facet Joint Dysfunction: The facet joints are the small joints that connect the individual bones in the neck called the vertebrae. These joints allow for movement of the neck and provide stability of the spine. When these joints become inflamed, injured, or get out of alignment, neck pain, stiffness and reduced mobility may result.
- Herniated Discs: The discs are gel filled structures that act as cushion or shock absorbers between the vertebral bones in your spine. They consist of a strong outer layer that protects the disc’s gel-like interior. If the outer layer weakens or tears, the disc may protrude into the spinal canal and affect nearby nerves, causing neck pain, arm pain or muscle spasm.
There are many other causes of neck pain including nerve and spinal cord problems, fracture and non-spine sources like tumor. It is important that your physician perform a comprehensive evaluation of your medical history and physical examination to give you an appropriate diagnosis for your neck pain.
Cellular Treatments that Help Resolve Neck Pain Naturally
Most cases of neck pain can be resolved with physical therapy, activity modification and over-the-counter anti-inflammatory medications. Lifestyle improvements such as maintaining proper posture and avoiding prolonged neck bending from the use of mobile devices (ie., “text neck”) are also helpful.
When neck pain persists, spine specialists can offer a number of options for long-lasting pain relief. Orthobiologics are cells and substances derived from cells that are naturally found in the body and have the ability to heal injured tissues. These cellular products are providing new options for treating stubborn neck pain.
· Platelet Rich Plasma puts the healing properties of the patient’s own blood to work in repairing damaged joints and helping with nerve pain. The platelets in the blood release growth factors and proteins that promote tissue repair, while the plasma carries the hormones, electrolytes and nutrients required to nourish cells during the healing process. PRP treatments should be customized to the particular individual and their injury in order to be effective.
· Cell based therapies use a patient’s own bone marrow or adipose (fat) tissue derived cells. These cells are comprised of adult stem cells and many other healing cells. They produce molecules that direct other cells in the area to form new blood vessels, decrease inflammation, awaken other stem cells and encourage formation of new healthy tissues. Stem cells are special cells that have the unique ability to develop into the specific kind of cell needed, whether that be a tendon, ligament, cartilage or bone cell. Skilled regenerative medicine practitioners use highly specialized processes to prepare these cells that are then delivered directly to the injured area to stimulate healing.
· Prolotherapy (Proliferative Therapy) uses dextrose and other natural substances that are injected into a chronically injured ligament, nerves or joint in order to help the body jump start its own natural healing response.
Applying Proven Treatments to Neck Pain
Regenerative medicine specialists have been using orthobiologics in the past decade with great success to treat other orthopedic conditions, including knee arthritis, back pain, tennis elbow, tendon tears and more.
A select few qualified physicians are now applying their experience to put these powerful sources of healing to work to address neck pain. To ensure maximum safety and efficacy, patients considering orthobiologic treatments for chronic neck pain should take note of the following important points:
- Cells are derived from your own body: Regenerative products that come from your own body (autologous) have been proven to be safe and effective in peer-reviewed research. The U.S. Food and Drug Administration (FDA) currently does not allow the use of donor stem cell products derived from amniotic fluid or other fetal tissues to treat orthopedic conditions since they have not been proven in safety and efficacy. These products also pose a risk of disease transmission or immune reaction. Moreover, these donor tissues do not to contain living stem cells, as opposed to what is claimed by the companies that market these products.
- Customized treatment: The best outcomes occur when your own cells and platelet rich plasma are prepared using the most advanced protocols to create a treatment that is customized to your specific injury.
- Targeted delivery: To maximize effectiveness, these regenerative treatments should be delivered under image guidance with fluoroscopy (x-ray) or ultrasound to ensure precise delivery to the injured area. Only physicians with fellowship training in advanced image guided procedures are certified to perform these procedures.
- Expert physicians: If you are considering regenerative medicine for the treatment of your spine condition, seek a board-certified physician who specializes in treating orthopedic injuries and has advanced training in regenerative medicine. These physicians are best suited to obtain the best results employing the latest research, technology and safety protocols.
Since orthobiologic treatments for neck pain are relatively new within the field of regenerative medicine, patients need to ask the right questions and research the appropriate physicians to deliver the best care.
Drs. Christopher J. Rogers and Mary A. Ambach of San Diego Orthobiologics Medical Group together have successfully treated thousands of patients with cell-based therapies for more than three decades. They are published authors and stem cell researchers who were chosen to participate in a first of its kind, FDA-approved clinical trial to treat knee osteoarthritis. The SDOMG facility in Carlsbad contains the most advanced Regenerative Medicine technology in San Diego and offers same day treatments with the highest level of safety, efficacy and patient satisfaction.
On November 18th from 12:00 -1:00 pm PT, Dr. Chris Rogers and Dr. Mary A. Ambach will present on cell-based therapies.
Webinar on Non-Surgical Treatment Options for Osteoarthritis
Join our free webinar to learn about innovative Cell based therapies as a non-surgical treatment option for osteoarthritis and other orthopedic conditions.
Click HERE to register for the webinar!
Dr. Mary Ambach specializes in non-surgical orthopedics, regenerative therapies, and interventional pain management. As a key thought leader in the field of Regenerative Medicine, Dr. Ambach conducts research, trains physicians, and lectures at international medical conferences.
Dr. Christopher Rogers is one of the world’s leading experts in orthopedic regenerative medicine and a renowned speaker at national medical conferences. He has developed new approaches for the treatment of tendon injuries, osteoarthritis, and disc degeneration which provide a safe and viable alternative to surgery.
Regenerative medicine represents a complete breakthrough in modern medicine. The body’s ability to heal itself naturally is actually not a new thing. A fractured bone will regrow and heal the break. Cut yourself shaving, and the skin will heal. There are many examples of our body’s innate ability to heal injuries.
Now modern science and technology are now enabling physicians to help their patients discover new ways in which the body can heal itself. Within the specialty of orthopedics, regenerative medicine is offering healing and pain relief to patients who suffer from conditions such as osteoarthritis, herniated discs or ligaments and tendons injuries.
Orthobiologics Can Boost the Body’s Own Natural Healing Abilities
Orthobiologics are cells and substances derived from cells that are naturally found in your body. By concentrating them and delivering them to the site of injury, they can help speed up the healing process.
Here’s how it works:
When you injure a bone, muscle or tendon, the platelet cells in the blood are the first responders arriving on the scene to quickly start healing. White blood cells also rush to the injury site to ward off infection, control inflammation and become the clean-up crew [i]. Other important cells like stem cells participate in this complex symphony of repair. Specialists in orthopedic regenerative medicine can now boost these natural processes through several specialized treatments that help maximize the body’s own innate healing capabilities.
Regenerative Treatments for Orthopedic Conditions
There are different orthobiologic treatments that your regenerative medicine specialist can recommend depending on your orthopedic condition:
· Platelet Rich Plasma puts the healing properties of the patient’s own blood to work to repair damaged joints, tendons and muscles. The platelets in the blood release growth factors and proteins that promote tissue repair, while the plasma carries the hormones, electrolytes and nutrients required to nourish cells during the healing process. PRP treatments are customized to the particular individual and their injury in order to be most effective.
· Cell based therapies use cells derived from the patient’s own bone marrow or adipose (fat) tissue. These cells include adult stem cells and many other healing cells. They produce molecules that direct neighboring cells in the area to form new blood vessels, decrease inflammation and encourage formation of new healthy tissues. Stem cells are special cells that have the unique ability to develop into the specific kind of cell needed, whether that be a tendon, ligament, cartilage or bone cell. Skilled regenerative medicine practitioners use highly specialized processes to prepare these cells that are then delivered directly to the injured area to stimulate healing.
· Prolotherapy (Proliferative Therapy) uses dextrose and other natural substances that are injected into a chronically injured ligament, tendon, nerves or joint in order to help the body jump-start its own natural healing response.
Beware of Imposters
As regenerative treatments have become more widely recognized for their ability to address orthopedic conditions and the chronic pain associated with it, more and more clinics are trying to get in on the action.
If you are considering regenerative treatments for pain related to osteoarthritis, tennis elbow, degenerative discs in the spine or other conditions, you should perform due diligence on the clinic that offers it. The source, processing and delivery of the regenerative materials are critical to the success of the treatment.
Currently, the U.S. Food and Drug Administration (FDA) does not allow the use of stem cells derived from birth tissue products (amniotic fluid and tissue, umbilical cord blood) to treat orthopedic conditions because these donor products have not been proven to be safe or effective. Our board-certified specialists only use your own cells (autologous) to treat orthopedic conditions.
Maximizing the effectiveness of these treatments requires a state-of-the-art facility and equipment, as well as knowledge and experience in fluoroscopic (x-ray) or ultrasound guidance to ensure targeted delivery of the healing cells to the injured area.
Orthobiologic treatments that capitalize on the body’s own natural healing abilities is one of the most exciting opportunities in modern medicine to address and resolve the chronic pain associated with orthopedic conditions that affects millions of Americans.
Drs. Christopher J. Rogers and Mary A. Ambach of San Diego Orthobiologics Medical Group together have successfully treated thousands of patients with cell based therapies for more than three decades. They are published authors and cell therapy researchers. Their facility in Carlsbad contains the most advanced Regenerative Medicine technology in San Diego and offers same day treatments with the highest level of safety and efficacy.
According to the U.S. Centers for Disease Control, an estimated 1 in 5 Americans, more than 50 million people, suffer from chronic pain. And, 20 million of these people suffer from pain that interferes with their lives every day.[i] Advances in medicine provide new hope to those living with chronic pain. Orthobiologics are products derived from your own cells and substances derived from those cells that are found naturally throughout the body. They can be used to treat orthopedic conditions and in many cases, avoid the need for surgery. [ii]
Scientific evidence from years of research have shown that Orthobiologic therapies that use your own cells, such as Platelet Rich Plasma (PRP) bring long-term pain relief and at the same time reduce degeneration and stimulate tissue healing.
Which conditions can be treated with Orthobiologics?
- Joint pain due to osteoarthritis or meniscus tears
- Shoulder pain due to rotator cuff tendon tears or tendinitis
- Carpal Tunnel Syndrome
- Golfer’s Elbow and Tennis Elbow
- Chronic ankle ligament sprains
- Low back pain due to degenerative discs or sacroiliac joint ligament injuries
The severity of injury as well as the patient’s overall health will influence the treatment’s ability to resolve these painful conditions.
How do Orthobiologics Work?
Stem cell therapies and platelet rich plasma (PRP) treatment offer unique healing capabilities.
Adult Stem Cells can be obtained from your own adipose tissue (fat) or bone marrow and produce molecules that directly form new blood vessels, reduce inflammation and encourage tissue healing. The adipose and bone marrow tissues are obtained from the patient in the clinic with local anesthetic, prepared in a lab, and then injected into the anesthetized injury site.
Platelet Rich Plasma (PRP) use platelet cells from your own blood to reduce inflammation and stimulate healing. Plasma, the fluid part of blood, contains hormones, electrolytes and nutrients that nourish cells during the healing process. Platelets are cells that release growth factors and proteins that promote tissue repair.
How to find the best doctor for you:
With more and more medical clinics offering cell based therapies, it is important to ask specific questions and demand specific answers about how these treatments are performed.
Ask your doctor these important questions:
- Which products do you use? The US Food and Drug Administration (FDA) allows the use of your own cells and tissues that are minimally manipulated for orthopedic conditions. Commonly used tissues include your own blood, fat or bone marrow. Donor-derived products, such as birth tissues (e.g. umbilical cord blood, amniotic fluid, placenta and exosomes) have not been proven to be safe or effective and are not permitted by the FDA for use in the United States.
- Are you licensed to treat my medical condition? Orthopedic conditions are typically managed by board-certified orthopedic surgeons, physical medicine physicians, fellowship trained sports medicine physicians or pain management physicians. Chiropractors, naturopaths and primary care physicians without specialized training are not trained to diagnosis or manage these types of medical conditions.
- Does your clinic use the proper lab equipment designed to provide customized same-day treatments? The more advanced physicians who offer orthobiologic therapy can produce a variety of types of therapy, prepared with the highest standards of lab practice.
- Are the treatments customized to my specific medical condition? Every person is unique and the treatment must be customized to fit your condition.
- Do you use image guidance with x-ray or ultrasound to inject the orthobiologics into the correct tissues? Fellowship trained physicians have advanced training in the proper use of image guidance to ensure safety, efficacy and comfort.
- Do you track your patient outcomes in a data registry or participate in clinical trials?
- Do you publish scientific papers in the peer-reviewed medical journals?
When patients do their homework and ask the right questions they will find the best healthcare provider for their specific needs. They will learn that orthobiologics can treat chronic orthopedic conditions without the need for major orthopedic surgery, enjoy a quick recovery and regain the quality of life that they deserve.
Drs. Christopher J. Rogers and Mary A. Ambach of San Diego Orthobiologics Medical Group together have successfully treated thousands of patients with cell-based therapies for more than three decades. They are published authors and stem cell researchers. The SDOMG facility in Carlsbad contains the most advanced Regenerative Medicine technology in San Diego and offers same day treatments with the highest level of safety, efficacy and patient satisfaction.
What are Exosomes?
Exosomes are microscopic bubbles packed full of proteins and genetic material such as DNA and RNA. When released from cells they allow those cells to communicate with each other. The molecules and genetic material direct cell behavior such as cell growth or differentiation.
In the past decade, interest in exosomes has exploded for several reasons. First, they allow communication between cells and aid in tissue repair and regeneration. Second, they have been proposed to be useful vehicles for drugs and could be used as therapeutic agents. Third, they can be useful biomarkers of disease which aids in diagnoses and prognosis.
What is the difference between Exosomes and Stem Cells?
Stem cells are living things that have the ability to renew themselves and to turn into different kinds of cells. They contain thousands of molecules known to decrease inflammation, regenerate tissue and fight infection. Exosomes are substances secreted by all cells, including stem cells.
During the repair process, different kinds of cells or molecules are needed at the different stages of healing. The stem cells act like the conductor in an orchestra, directing cells where to go and what to do. They organize the complex symphony of cellular activity that leads to tissue healing. Different types of exosomes are produced by the stem cells and released at different times depending upon the needs of the body.
Can we use manufactured products that contain exosomes to treat orthopedic conditions?
There are currently no FDA approved exosome products. These products require FDA approval before they can be marketed for use in patients. Their safety and efficacy have not yet been proven. Although they have the potential to repair injuries and regenerate tissues, there is still much to be learned about their behavior in the body. Patients should avoid exosomes until research studies prove they are safe and effective.