Regenerative Medicine procedures stimulate a healing and tissue growth response inside damaged tissue using 1 of 4 techniques: Prolotherapy, Platelet Rich Plasma, Adult Autologous Mesenchymal Stem Cells, or Amniotic Derived Allografts.
Prolotherapy uses a concentrated dextrose (sugar-based) or saline (salt based) solution that is injected into the area of degeneration such as joint arthritis, tendon/ligament/muscle tearing, or spinal disc. The solution acts as an irritant which promotes healing by stimulating the body to provide additional blood supply to the injured area. This additional blood flow brings the nutrients and repair cells that lead to regeneration and healing of the injured tissue. Of the regenerative treatment options, prolotherapy is the weakest. The average treatments are 3-5 and treatments are space 6 weeks apart. For this reason, most patients do not choose this treatment option.
PRP stimulates a more intense healing response than prolotherapy because instead of injecting a concentrated dextrose solution, we draw your own blood, isolate the portion that is responsible for stimulating growth and healing (the platelet rich plasma portion), then re-inject the growth solution into the area of degeneration. The amount of blood drawn will varying based on the area of concern as well as concentration of PRP desired. Average amount of blood drawn is 120cc, which is comparable to 1/5 of the amount for blood donation. Your blood is processed and separated out into platelets, growth factors and a small amount of stem cells in our lab using a specialized centrifuge and flow cytometer. The solution is then injected approximately 30 minutes after it is drawn using ultrasound or fluoroscopic (x-ray) guidance, inserting your body’s healing cells directly at the sites of degeneration. The healing cells cause regeneration/healing of chronic injuries, sports injuries, or other natural degenerative processes. Average treatments for PRP are only 1-2 making them much for time and cost effective for patients than prolotherpay. The difference between Prolotherapy and PRP is that Prolotherapy stimulates the body’s healing cells to target the area of degeneration, whereas PRP takes your healing cells, concentrates them, and then directly injectes them to the areas of degeneration. PRP is a much stronger stimulus for healing, and therefore will require fewer treatments to achieve the same end result much faster. If repeat injections are needed, treatments are generally spaced at least 6-8 weeks apart, allowing for proper healing cascade to take effect. Some personal factors that may inhibit maximum healing include age over 80, smoking, poor nutrition, diabetes and other immune suppressing conditions.
Adult Autologous Mesenchymal Stem Cells (MSCs):
The term stem cell elicits some potential ethical concerns. I want to start the description of this procedure by first assuring you we are not talking about embryonic stem cells, cloning, or harvesting cells from anyone other than yourself for your own use. The cells we obtain are the same cells that are designed to repair tissue in your body, we are simply isolating them, concentrating them in a syringe, and injecting them exactly where we want them to go. In other words, we are simply augmenting your body’s natural ability to heal itself. The MSC procedure is a 3 step procedure, all conducted on the same day. Step 1 is the identical blood draw procedure and process described in the PRP section above where, on average, 120cc of blood is drawn and put through our lab to create the PRP. Step 2 involves a bone marrow aspiration to obtain your own stem cells. This sounds painful, but if done with the proper technique and proper equipment, it is NOT. We use ultrasound or fluoroscopy to identify the point on the back side of your hip bone called your posterior superior iliac spine (PSIS), and then use sufficient local anesthetic to numb all the tissues between your skin and your PSIS. The bone needle (called a trochar) is then gently inserted into the bone and the marrow is aspirated. I have had my bone marrow harvested, and can attest that the procedure is not painful. After the harvest, the bone marrow is then immediately transferred to the centrifuge machine in our lab which then isolates the MSCs out of the bone marrow and places them in a separate syringe. Step 3 involves the actual injection of the PRP and the Stem Cells into the targeted areas of injury. This injection is also done with either ultrasound our fluoroscopic guidance to assure it is injected into the exact proper location.
Amniotic Derived Allograft (aka Umbilical Cord Stem Cells):
In cases where a patient’s PRP or MSCs are not of sufficient quality due to age or other medical conditions, we may consider using a solution or a graft obtained from donors of amniotic membranes, amniotic fluid, or umbilical cords. I again will begin this section by addressing the potential ethical concerns surrounding this regenerative procedure tissue source. The only source for this tissue is from consented mother’s of term delivered babies who gave birth by a scheduled c-section in the United States. No children or mothers are put at risk or exploited to obtain this tissue and solution. This tissue and solution are acellular, meaning that they contain no cells, and are certified to be disease free by the same process that blood donations must pass. The umbilical cord tissue and solution contains many of the same growth factors found in PRP, and can stimulate growth and healing similar to PRP. I recommend this treatment for cases that have not responded to PRP or MSC procedures because of patient related factors such as age, diabetes, smoking, heart failure, or immune suppressing conditions that can all reduce the potency of injected cells that come from the patient.
Stem Cell Series (SCS):
The stem cell procedure can be given as a series of the following treatments which is probably the best way to get the most optimal outcome as it mimics the human body’s natural response to trauma and the natural healing process. We like to describe this process using a farming analogy as we are essentially trying to farm cells in your body:
Day 1- Prolotherapy Day
We refer to this as “Tilling the Soil” as Prolotherapy acts as a pre-injection, priming or irritating the area, preparing the degenerative target for stem cell adhesion and growth. Stem cells are known as a “chameleon cell”, therefore, prolotherapy helps to create the proper environment to stimulate the stem cell to grow into the desired cell type (for example cartilage, ligament, or tendon depending on what structure we are injecting).
Day 2 – Stem Cell Day (2-4 days after the Prolotherapy injection)
We refer the stem cell injection as “Planting the Seeds.” This procedure is performed on the same day of the bone marrow draw as described above in the Adult Autologous Mesenchymal Stem Cell procedure. The solution is injected to the same areas prepped by the prolotherapy injection.
Day 3 – PRP reinject day (2-4 weeks after the Stem Cell injection)
We refer to this step as the “Fertilization Phase.” PRP acts as a post injection cell growth stimulator, supplementing and fertilizing the stem cells. You will again have a blood draw prior to the procedure similar to the description for the PRP injection above. The PRP is injected in the same locations as the stem cells were injected and the same guidance technique (ultrasound or fluoroscopy) is utilized again as well to assure precise locations are repeated.