Regenexx Blog
POSTED ON 11/7/2018 IN SPINE BY CHRIS CENTENO

Click for video:

https://www.regenexx.com/blog/areas-...-cells-or-prp/

A few years back I would never have believed that you could treat spinal stenosis without surgery. Since then, we have been at the forefront of spinal stenosis surgery alternatives through the use of precise platelet and stem cell procedures. How is this possible? Let me explain.

First, if you really want to understand this blog, please watch my video above.

What is Spinal Stenosis?
Each of the spinal vertebrae (spine bones) have a hole in the middle which is called the spinal canal. This is where the spinal cord and nerves run. If other structures inside or outside the spinal canal put pressure on these nerves, it's called spinal stenosis.

What Causes Spinal Stenosis?
The spine bones can become unstable, which means that they can get sloppy and move around too much. This happens because the ligaments and muscles that normally stabilize the spine become loose or atrophied. This motion can cause extra stress on the discs, facet joints, and the ligament inside the spinal canal called the liagamentum flavum. This, in turn, causes these structures to get larger and press on the nerves in the spinal canal. Since these nerves are pain sensitive and power your legs, you can get low back pain as well as weakness or numbness in your legs or feet.

What Are the Classic Symptoms?
The biggest tell-tale sign that you have spinal stenosis is standing intolerance. In these patients, standing for any length of time causes back pain or leg symptoms that get immediately better on sitting. In addition, patients often notice that if they bend forward while walking (like leaning on a shopping cart), they have fewer symptoms.

What Are the Most Common Treatments?
Steroid injections are often used to help reduce swelling around the pinched nerves. The problem here is that these high-dose steroids can damage tissue. In addition, they often only work temporarily to control pain.

Surgery is also an option and the focus in that case is to remove bone and structure to open up the spinal canal. The biggest issue is that these surgeries are massive and incredibly invasive. These days fusion is often used and this can lead to adjacent segment disease. To understand that side effect, see my video below:



So are there spinal stenosis surgery alternative? Let's explore that idea.

Spinal Stenosis Surgery Alternatives Are All About Fixing the Sloppiness
Remember when I said that spinal stenosis was caused by vertebrae that became sloppy and moved too much, which in-turn wears out the joints, discs, and ligament inside the canal? What if we could non-surgically tighten down those structures and reduce the sloppiness? Things might actually start to heal. What if we could place healing growth factors around damaged nerves and into damaged facet joints? This is the focus of the Regenexx DDD procedure. Let's explore that further.

The Regenexx DDD Procedure Is the World's First Regenerative Spinal Stenosis Surgery Alternative
Four main precise procedures make up our DDD treatment protocol:

•Percutaneous Ligamentoplasty - precise ultrasound and fluoroscopically guided injections to tighten loose ligaments and reduce instability and pressure on the spinal canal. This includes the supraspinous, interspinous, and iliolumbar ligaments. Another injection target is often the swollen liagmentum flavum in the spinal canal.

•Percutaneous Facet Joint Arthroplasty - precise fluoroscopically guided injections to help reduce swelling and breakdown of facet joints

•Percutaneous Biologic Neuromodulation - precise fluoroscopically guided injections to reduce swelling and increase blood supply of spinal nerves

•Percutaneous Myoplasty - Precise ultrasound guided injections into atrophied spinal stabilizing muscles

Notice that due to the "Percutaneous" moniker, these are all precise x-ray or ultrasound-guided injection procedures and that this is not just another surgery.

What Do We Inject?
Since we've been perfecting orthobiologics for use around the spine for almost a decade and a half and were the first human beings on earth to inject stem cells into a low back disc, we've learned a thing or two and evolved several injectates to perfect this procedure. Our most common ones used include:

High dose 3rd and 4th generation platelet lysates
High dose 3rd generation platelet-rich plasma
These are both derived from a simple blood draw and both are quite different than what you can get in a clinic that uses a simple bedside centrifuge.

Can this procedure be done with stem cells? Yes, but in our experience, most patients respond to far less invasive and less expensive platelet-based procedures.

How Could this Work?
Don't you need to surgically remove what's pressing on the nerves? In a few cases yes, but in most cases no. Why? The main culprit causing the symptoms is usually the ligamentum flavum that lives inside the spinal canal. It gets weak and hypertrophied just like all dysfunctional ligaments and tendons do. Knowing how to inject substances that will heal the ligament and make it stronger as well as tighten the ligaments that connect this structure to the back muscles is all that's needed to gain that extra millimeter or two that's needed to open up room for the nerves. In addition, remember that pain is a neurochemomechanical phenomenon, meaning it's as much about mechanical pressure as it is irritated nerves and bad chemicals in the area. Finally, surgery that cuts stuff out weakens the spine usually sets people up for future problems.

Who Can Perform this Procedure?
First, who can't perform this procedure? A nurse in a chiropractic office is not skilled enough nor would she be trained enough to perform these exacting and precise image-guided spine procedures. So if a chiropractor, acupuncturist, or naturopath tells you he or she can do this, please run. While an interventional spine doctor could theoretically perform this procedure, he or she would need substantial additional training to understand what is being injected and how, as none of these procedures are part of the traditional training for these doctors. So if an interventional spine doctor says that he or she uses PRP, it's very, very unlikely that they understand what is being injected here, and how.

The upshot? I have been blown away these past few years that it's possible to effectively treat spinal stenosis without a surgical decompression. There are reasons this works, which are explained in the video and above. So if you have spinal stenosis, try as hard as you to avoid invasive surgery and harmful steroid injections!