Dr. Mary Ambach lectures to physicians, orthopedic surgeons and other orthopedic practitioners on the use of Platelet Rich Plasma and Stem Cell Therapies for the Spine.
Dr. Ambach is one of the esteemed instructors in this Orthobiologic seminar who taught physicians on how to perform regenerative injections and diagnostic musculoskeletal ultrasound scans.
Dr. Ambach has served as faculty and speaker at regenerative conferences in and outside of the country. She has mentored many doctors all over the world in innovative procedures using cell therapies from our own bodies to heal our own orthopedic injuries.
The bones of the spine called vertebrae are separated by shock-absorbing discs that act as a cushion. These discs have a strong cartilaginous outer portion and a gel-like inner core. When these discs begin to break down from either age or injury, they can result in disc bulging or what is also known as disc herniation.The discs can also tear, decrease in height or dry out. These changes in the discs can cause pain and pressure on nearby nerves ( radiculopathy). They can also cause degeneration of nearby facet joints and narrowing of the canal (spinal stenosis).
Degenerative disc disease often occurs as part of the aging process. By age 40, it is estimated that 40 percent of the population will have some degree of degenerative disc disease and by age 80, that percentage doubles.[1]
Symptoms from degenerative disc include neck pain, back pain, muscle spasms or radiating pain to the arms or legs. Pain is typically worse with bending forward or prolonged sitting.
The current standard treatment for degenerative or herniated discs includes physical therapy, medications, injection therapy, and surgery. These aim to provide symptomatic relief of the pain but most do not improve the pathology or reverse the degenerative process.
Treatment with Bone marrow-derived cells has introduced a unique approach to alleviate pain and improve function by restoring and repairing tissue injury.
What is Bone Marrow Aspirate Concentrate (BMAC)?
The body’s bone marrow possesses unique properties that help the body heal itself naturally. It contains important therapeutic cells, growth factors and proteins that stimulate the body’s natural ability to improve circulation, decrease inflammation and heal injured tissues.
It also contains adult stem cells called Mesenchymal stem cells. These stem cells have the special ability to renew themselves and differentiate into bone, tendon, cartilage and muscle cells. These make them an ideal therapy for treating orthopedic injuries such as tendon tears, worn cartilage, and degenerated disc disease.
Bone marrow-derived cells have been shown to stimulate disc cell proliferation, increase disc support tissue, increase disc hydration, decrease inflammation, and support tissue healing.
How Effective is BMAC?
A study published by International Orthopedics reported the results of 26 patients suffering from degenerative disc disease and were candidates for major surgery such as spinal fusion or total disc replacement who underwent BMAC therapy to their discs. Three years later, 73% of these patients showed improvement in pain, 70% showed improvement in function, and 75% avoided surgery.[2]
A systematic review of seven clinical trials with a total of 97 patients and up to 72 months follow-up concluded that treatment with Bone Marrow-derived cells intradiscally showed significant improvement in pain and function with low re-injection or complication rates.
BMAC therapy is a minimally invasive, non-surgical procedure that does not require hospitalization or lengthy rehabilitation. Patients are generally able to begin physical therapy and gradual resumption of their daily activities within a week.
For patients who suffer from chronic low back pain from degenerative disc disease and failed standard conservative therapy, BMAC therapy performed by an experienced regenerative medicine specialist can provide an innovative, non-surgical treatment solution. Schedule a consultation with our renowned regenerative medicine physicians to see if you are a candidate for these therapies before considering spinal surgery.
Drs. Christopher J. Rogers and Mary A. Ambach of San Diego Orthobiologics Medical Group together have successfully treated hundreds of patients with BMAC and other cell-based treatments for more than three decades. They have published authors and stem cell researchers. Their FDA-compliant 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.
Dr. Christopher Rogers was honored to speak at the April 2021 La Jolla Golden Triangle Rotary Club meeting. Topics of the lecture included a history of stem cell therapy in San Diego and an update on FDA-approved clinical trials for knee osteoarthritis. To see a copy of the lecture, visit the San Diego Orthobiologics Medical Group YouTube channel or view the video linked below!
The researchers and scientists of the International Human Genome Project first mapped our full genetic blueprint 18 years ago.[i] Their breakthrough efforts enable numerous advances in how we treat and prevent various diseases and orthopedic conditions.
The Human Genome roadmap allows us to better understand the genes that are associated with certain diseases and how these genes can predispose a person to develop these diseases. It can also help in understanding how genes can be altered to improve disease processes.
In the field of orthopedics, a group of scientists at Stanford University discovered a biological indicator of cartilage degeneration and inflammation in patients with arthritis, disc degeneration, and sciatica.This molecular complex is called the Fibronectin-Aggrecan Complex or FAC.
Alpha-2-Macroglobulin (A2M) is a Master Protease Inhibitor
Having identified the FAC molecular complex, the Stanford team recognized how this biomarker could be used in conjunction with a naturally-occurring blood protein called Alpha-2 Macroglobulin or A2M to improve the effectiveness of treatments for degenerative disc disease and joint arthritis. The FAC can be measured to predict which patients will have the best results with A2M therapy.
A2M inhibits the breakdown of collagen in cartilage and has been scientifically proven to stop the progression of joint cartilage and disc degeneration. It is known as a Master Protease Inhibitor. It inhibits proteases, which are enzymes that breaks down proteins in cartilage.Much like a levee along a rising river, it “holds back” and prevents damage to tissues.
How A2M therapy Works
A2M therapy is a non-invasive treatment performed on an outpatient basis. After conducting a complete examination, your physician will determine if you are a good candidate for this treatment.Further imaging studies such as x-ray, ultrasound, or MRI may be necessary to determine the cause of your pain.
The A2M procedure starts with a simple blood draw from the arm. The treatment is autologous, which means the A2M is derived from the patient’s own body. There are no donor products used. The blood is concentrated using an FDA-approved device in our lab.After numbing the treatment area, the concentrated A2M is injected on the same day.Digital x-ray or ultrasound guidance will be used to make the treatment comfortable, safe and precise.
Currently, this breakthrough treatment is only being offered by a select number of physicians across the country.By screening patients for these treatments, regenerative medicine specialists are able to offer targeted A2M treatment to appropriate patients. This gives patients new hope for relief of pain and inflammation due to common orthopedic conditions.
Drs. Christopher Rogers and Mary A. Ambach of San Diego Orthobiologics Medical Group are two of just a handful of physicians in San Diego who offer A2M therapy for their patients.They have found this and other new regenerative medicine therapies valuable for the treatment of pain and inflammation associated with arthritic joints and disc degeneration.
Regenerative medicine uses the natural healing capabilities of stem cells to help repair injured tissues. One of the biggest challenges facing practitioners of this exciting new medical subspecialty is helping patients understand that not all stem cells are the same.
The ABC’s of Stem Cells
Stem cells are unique because they have the ability to renew themselves and become different kinds of cells that are needed by the body. In fact, they are the only cells in the body that are capable of generating new cell types.[i]To better understand what kind of stem cells are used for orthopedic conditions, it is helpful to know that there are several different types.
Embryonic stem cells are derived from an embryo that develops from fertilized human eggs in the laboratory. They are used for research purposes only.There are no FDA approved treatments that use embryonic stem cells.
Stem cells derived from birth tissue products such as umbilical cord blood are approved for use in blood cancers and other blood disorders like sickle cell disease.However, the stem cells from umbilical cord blood and amniotic fluid are not approved by the US Food and Drug Administration (FDA) for any orthopedic indication. The safety and efficacy of these products have not been tested in orthopedic conditions and the FDA does not permit their use.
Mesenchymal stem cells (MSCs) are a specific type of adult stem cell that have the ability to differentiate into bone, cartilage and muscle cells.[ii] These stem cells are found in all tissues of our body in limited quantities, but they tend to exist in higher amounts in the bone marrow and adipose tissue (fat).For orthopedic applications, your physician may obtain these cells from your own (autologous) bone marrow or adipose tissue (fat).These tissues not only contain mesenchymal stem cells, they also contain other cells that are anti-inflammatory and regenerative. Once these cells are injected, they release hundreds of molecules that decrease inflammation, fight infection and repair injured tissues.
The Body: A Constant Work in Progress
There are more than 37 trillion cells in our body which are constantly dying and being replaced. There are more than 200 types of cells in our body and they each have different lifespans. Platelets live for a week, red blood cells live for about four months, bone and muscle cells live about 25 years, while brain cells can live a lifetime.
An injury or disease can hasten the death of cells. But often, the wear-and-tear of the natural aging process cause tissues to become damaged.Stem cell treatments enable regenerative medicine specialists to boost the body’s own natural healing abilities by bringing concentrated doses of these powerful building blocks directly to the site of injured or degenerated joint, cartilage or tissue.
Although regenerative medicine is a relatively new specialty within the field of orthopedics, cell-based treatments have been shown to be an effective non-surgical option for patients who have failed standard treatments or want to avoid surgery.
By combining the body’s own powerful healing capabilities with the latest in scientific and medical technology, orthopedic stem cell therapies provide lasting pain relief and help patients live their life fully.
Drs. Christopher Rogers and Mary A. Ambach have been providing cellular treatments for orthopedic conditions for more than three decades. Their clinical outcome data reveals that the majority of their patients are satisfied and successfully respond to these orthobiologic therapies which also demonstrate excellent safety.
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 thelower back, the discsare 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
Genetics
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.
Treatment Options
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.
Non-Surgical Interventions
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 proceduresand 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.
