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Bone Marrow Derived Stem Cell Injections

Regenerative medicine provides the opportunity for a real cure with stem cells, platelet rich plasma, and growth factors to heal damage.  A person’s own bone marrow contains a substantial amount of the stem cells and additional biologic materials necessary for regeneration, with the added benefit of being low risk and outpatient.

What are bone marrow derived stem cell injections? The main reason that stem cells are used as therapy for arthritis and other conditions that experience joint pain is that they maintain regenerative properties with the potential to repair and reverse damaged joints. Knee stem cells Bone marrow is a spongy tissue contained inside one’s bones, and makes cells that are crucial to existence including platelets, white blood cells, and red blood cells.  All of these cells start in the marrow as stem cells, which are basically a “blank slate” type of cell.  With a “blank slate”, the cell can then turn into many different types of cells needed in the body including cartilage, tendon, or muscle.  There are three types of adult stem cells in the human body.  The first type of stem cells turns into blood components, with a second destined to become lining of the endometrium.  The third, and most important for musculoskeletal regenerative medicine, are mesenchymal stem cells found in bone marrow.  They have been used in animal models to regenerate cartilage and in human models to regenerate bone.  The largest and easiest sources of stem cells for concentrated amounts of bone marrow are in the iliac crest of the hip.  We use the posterior superior iliac crest for our procedures in an outpatient setting. Below is an MRI of a 33 year old soccer player with a defect of the patella bone of the knee on the left image, and two years following treatment with mesenchymal stem cells on the right image.  Note that the defect shows good coverage of the lesion. Harvest Stem Cells Patella Web

How are these injections performed? First the stem cells will be extracted from the patient’s hip bone.  The area will be numbed considerable for pain control.  With the patient’s ability to quickly make new bone marrow, the harvesting does not present any lasting problem. Approximately 60 ccs of bone marrow is harvested.  We use the Harvest BMAC system for our advanced cellular therapies. Once the marrow is harvested, it is placed in a centrifuge and spun until a concentrated substance is obtained consisting of the most important regenerative components.  Afterwards, the patient is injected with the substance in the same setting. Harvest Stem Cell Process Web

Harvest Stem Cells Centrfuge Web

Is the procedure painful? Harvesting bone marrow from the iliac crest may produce slight pain.  Plenty of Lidocaine numbing medicine will be used during the procedure.  There may be some discomfort at the hip area that may persist for a few days until the area heals.  The injection of the prepared bone marrow stem cells into the affected joint is no more painful than a typical steroid injection.  For a few days afterwards, the joint may have slight increased pain due to the inflammatory reaction generated.  This is normal.

Who do bone marrow derived injections help?

As with other types of regenerative medicine, bone marrow derived stem cell injections work better for some cases than for others.  There have only been small studies so far looking at bone marrow derived stem cell injections in humans.  In a 2011 study out of Beijing Institute of Technology, bone marrow mesenchymal stem cells were shown to have an excellent potential for cartilage production in animals (Li et al, 2011).  A recent study in canines showed that bone marrow mesenchymal stem cells were effective in repairing bone defects (Kang et all, 2013).   In Dr. Alberto Gobbi’s article on “The Future of Cartilage Repair and Protection”, he notes that knee articular cartilage has a limited intrinsic healing potential due to the presence of very few specialized cells with a low mitotic activity.  Furthermore, cartilage is avascular and there is a lack of source of undifferentiated cells that can promote tissue repair.  Unlike, highly vascular areas such as the tissues of the face, once injury occurs , knee cartilage, for example,  gradually degenerates and predisposed to early osteoarthritis.  Therefore it is critical to restore a smooth cartilage surface in order to withstand excessive joint mechanical stresses from shear and compressive load from cartilage to bone.  Mesenchymal stem cells harvested from bone marrow showed great potential in cartilage repair in his studies.

With positive results both in animals and humans, we offer bone marrow derived stem cell injections for the following conditions:

  • Extremity arthritis including knee, hip, ankle, and shoulders
  • Spinal arthritis in facet joints (Cervical and Lumbar areas)
  • Sacroiliac Joint Arthritis
  • TMJ Arthritis
  • Rotator Cuff Tendonitis
  • Achilles Tendonitis
  • Lateral Epicondylitis (Tennis Elbow)
  • Medical Epicondylitis (Golfer’s Elbow)
  • Ligament and Muscle Strains

How are these injections different from cortisone shots?

Bone marrow derived stem cell injections have the goal of repairing the damaged tissue while providing pain relief.  Cortisone shots simply provide anti-inflammatory medicine to reduce pain, but no reaction that pulls in stem cells or growth factors.

Are there risks with the procedures?

With the procedure being outpatient and minimally invasive, the risks are low.  There is the minimal risks of infection, allergic reaction, bleeding, pain at the harvest site, would drainage, and failure to relieve the pain.  Any concerns that you might have should be discussed with the doctor.  If you are interested in a stem cell injection, contact our office at (818) 360-4949.

Botulinum Toxin can put a cramp in muscle pain and spasm

Using Botulinum Toxin (Botox) for muscle spasms and pain can be effective in reducing excessive muscle tone, associated pain, and deformity.  The toxin has a high patient acceptance compared to systemic medications.  Improvement occurs within a week and its benefits last for months.  In addition, you can use botulinum toxin in conjunction with physical therapy.  More aggressive therapeutic exercise is tolerated during the response phase.  Pain relief usually lasts 4-6 months.  In some cases, no further treatment is necessary after the muscles have been adequately stretched.  Botulinum Toxins can manage the following conditions:

 Cervical Epidural 3

  • Cervical Dystonia. Cervical dystonia is a movement disorder that consists of involuntary contractions of the neck and shoulder muscles, which produce pain, spasm, and abnormal head positions.  Botulinum toxin is considered the first line therapy for mild, moderate, and severe symptoms of cervical dystonia. The condition is more common in females, and has a mean age of onset of 42.  It can be caused by hereditary neurological syndromes, environmental conditions (trauma, perinatal injury), Parkinsonism and psychogenic conditions.  The most common head posture in cervical dystonia is torticollis, where the head rotates to one side.  The sterilized toxin is FDA approved and is covered by most PPO insurances.
  • Blepharospasm, strabismus, and hemifacial spasm.  Other FDA approved indications for Botox include blepharospasm, strabismus, and hemifascial spasm.  Blepharospasm is a localized movement disorder that affects the muscles that control eyelid movement.  The disorder is characterized by increased blinking caused by involuntary spasms of the eyelid muscles.  An injection of Botox directly into the affected eye muscles can relieve these spasms..  Strabismus is a deviation in eye alignment.  Esotropia is the most common form of the condition and occurs when the eye turns toward the nose.  Injecting Botulinum Toxin into the muscle that’s pulling the eye inward or outward can help correct the problem.  Hemifacial spasm is a neurological disorder in which blood vessels constrict the 7th nerve and cause various degrees of spasm.  Botox controls these spasms in more than 90% of cases.

Botox1

  • Musculo-Migraine type headaches. Botulinum Toxin is FDA approved for treatment of musculo-migraine headaches when medications have become ineffective and the headaches have increased in both frequency and intensity.  We have had excellent results with treatment of Botox for migraine headaches.  Typical dosage for treatment range from 100-200 units of Botox.

Sweating eyebrow   Sweating 2

  • Hyperhidrosis- Excessive sweating of the hands, feet, and underarms.  Focal hyperhidrosis is a common condition associated with excessive sweating.  It usually involves the palms, underarms, face, or feet.  Affected patients may routinely soak through clothing in minutes, and resort to pads, shields, absorbent tissues, and frequent clothing changes to cope with the disorder.  Hyperhidrosis also has a significant psychological effect on the patient.  Typically, the patient has difficulty with social behavior in public such as shaking hands.  Often they are passed over on employment due to the excessive sweating.   Intracutaneous  injections of Botox abolishes focal hyperhidrosis by preventing the presynaptic release of acetylcholine in nerve endings.  When nerves are blocked, sweating decreases dramatically.  The optimal effect can last 4-12 months.  Dr. Jagodowicz specializes in treatments for hyperhidrosis and is well regarded in this field.
  • Temporomandibular disorders (TMJ).  Temporomandibular disorders consist of myofascial pain, internal derangement of the joint and degenerative joint disease.  Treating these disorders with Botulinum Toxin has improved the associated myofascial pain.  The toxin is injected into the lateral and medial pterygoids, as well as the temporal and masseter muscles.  The results are dramatic for patients with limitations opening the mouth.

Lumbar Pain

  • Back pain and spasms-Failed back syndrome.  Post-traumatic myofascial pain syndrome, piriformis syndrome,  paraspinous syndrome, and chronic back spasms respond well to Botox.  In addition, patients with repetitive strain injuries have benefited from its effects.

This article is a reprint from the March issue of Advance Rehabilitation, Muscle Power by Morris Jagodowicz, M.D.  If you are interested in treatments for pain with Botox, contact our office at (818) 360-4949.

 

Health Professionals

Referral of patients to Dr. Jagodowicz will be regarded as the private patients of the referring physician or chiropractor. Upon completion of therapy, reports of the patient’s progress will be sent to the referring entity along with recommendations for activity and time span for return to work

We accept all PPO insurances, Workman’s Compensation, Medicare, and Cash patients. We do not accept Medi Cal.

If you wish to be on our REFERRAL list, contact us and provide our office with information about your practice along with your business cards.

The cost of chronic pain is estimated to be $120 billion dollars per year in the UnitedStates. Approximately 28-30% of the U.S. population suffers from chronic painful conditions. 150 million workdays are lost each year in the U.S. due to back pain, which is estimated to cost $14 billion in wage costs alone.

Botulinum Toxin neurolysis offers a new and dramatic option for your patients with cervical dystonia, failed back syndrome, post-traumatic myofascial pain syndrome, and piriformis syndrome. In addition, patients who suffer from pain as a result of sustained or frequently repeated tasks at work have benefited from the effects of Botulinum Toxin. Possible mechanism of action for the toxin is, (1) diminished muscle tension, and contraction, thereby improves perfusion of muscle and restores muscle length and neutral mechanics, (2) reduces muscle spindle activity and decreases the feedback loop for recurrent contraction, and (3) inhibits cholinergic interneurons, thereby diminishes central sensitization to pain signaling and reduces A delta and C fiber pain activity.

After treatment with Botulinum Toxin , improvement is noted within 7-10 days. Following treatment, physical therapy is initiated to stretch and exercise the injected muscles. More aggressive therapeutic exercise is tolerated during the response phase. Duration of pain relief usually lasts 4 months or longer.

We have all experienced the frustration of the patient who still complains of back or neck pain, even after surgical correction such as fusion. Botulinum Toxin is an excellent option for such patients. It is well tolerated and has minimal side effects. Botulinum Toxin A and B are FDA approved for cervical dystonia and are covered by most insurances

If you would like any additional information concerning the benefits of Botox, Xeomin, Dysport, or Myobloc in the above pain syndromes, either contact our office or go to the “Botox Procedure” section of this website. If you have any patients that may benefit from this pain relief option, I would appreciate the referral.