Am I a candidate for Regenerative Medicine Interventions?
Like millions of Americans, you may be suffering from traumatic ordegenerative spine and joint conditions. If you have failed conservative therapy, or have been told that surgery is the next step, you may be a candidate for Regenerative Bio-Cellular Interventions.
What is Regenerative Medicine?
Regenerative Medicine– Is a multidisciplinary field of medicine, devoted to the treatment of conditions (due to injury or degeneration) by utilizing your body’s own biologic tissues and cells, to enhance tissue regeneration and restore function.
What are Bio-Cellular Regenerative Interventions (BRI)?
BRI Is a broad term used to describe different substances and tissue grafts utilized, in order to induce biologic enhancement of tissue repair and regeneration. Biologic Stimulants uses only substances to achieve its goal, while Bio-Cellular Grafts utilizes combination of growth factors, mesenchymal stem cells and biologic grafts. The above therapies are considered Tissue Engineering interventions due to the meticulous planning, designs, creation and application of the bio-cellular grafts.
What is Tissue Engineering?
The term Tissue engineering evolved from the field of biomaterials development and refers to the practice of combining scaffolds, cells, and biologically active molecules into functional tissues. The goal of tissue engineering is to assemble functional constructs that restore, maintain, or improve damaged tissues or whole organs.
Why are Bio-Cellular Regenerative Interventions necessary?
Because most common spine and musculoskeletal conditions are associated with injury or degeneration, due to the body’s inability to heal itself. Certain tissues such as joints, disc, tendon and ligaments, have limited blood supply and decreased regenerative potential, leading to chronic injury patterns. Surgery and or anti-inflammatory medications are not capable of inducing tissue repair or regeneration. Only Bio-Cellular Interventions are capable of inducing significant healing changes is these structures.
What conditions are usually treated with Bio-Cellular Regenerative Interventions (BRI)?
BRI are mostly performed on ligaments, tendon, joints (major and minor), discs and nerves. The following are commonly treated conditions:
Spine: Degenerative Disc Diseases, Sacroiliac Joint Pain, Ligament Sprains,Facet Joint Arthritis and Whiplash
Shoulder: Rotator Cuff Partial Tears, Shoulder Arthritis, Biceps Tendinosis, Sprain Ligaments
Elbow: Tennis and Golfer’s Elbow, Ulnar Collateral Ligament Injury, Arthritis
Wrist & Hand: Arthritis, DeQuervain’s Tendinosis, Carpal Tunnel Syndrome.
Hip/Pelvis/SI Joints: Pyriformis Syndrome, Greater Trochanteric Bursitis, Sacroiliac Joint Dysfunction, Hamstring Strain, Bursitis, Hip Joint Arthritis.
Knee: Jumpers Knee, Osgood-Schlatter’s Disease, Medial and Lateral Collateral Ligament Tears, Arthritis ,Patellar Chondromalacia , Meniscus Tears.
Ankle & Foot: Chronic Ligament Strain, Achilles Tendinitis, , Plantar Fasciitis, Joint Arthritis.
What are Bio-Cellular Regenerative Products?
Bio-Cellular products is the term used to describe different types of chemicals, tissues and cells, harvest from your body, which are capable of significantly stimulating your body’s regenerative potential.
What are the different types of Bio-Cellular Regenerative Interventions?
A- Biologic Stimulants Therapies (BST) Is a type of therapy in which mostly natural substances are injected into the specific tissues (joints, discs, nerves, ligaments, tendons), in order to enhance the natural healing capabilities of damage or degenerative tissues. They can be use alone and more frequently in combination with other bio-cellular therapies.
- Prolotherapy (Creates cellular proliferation)
- Ozone (Increases tissue oxygenation)
- Traumeel (Homeopathic anti-inflammatory)
- Viscous Supplementation (Increases joint lubrication)
- Peptide Therapy (stimulates production of cartilage cells)
- Hormone Therapy (accelerate protein synthesis)
B- Bio-Cellular Graft Therapies Is a type of Bio-Cellular Regenerative Therapy used in the treatment of moderate to advanced degenerative conditions or injuries. It utilizes blood derived growth factors PRP (which are chemicals that instruct cells to perform specific tasks) and Mesenchymal Stem Cells derived from your bone marrow or adipose tissues.
These are frequently combined with your of tissue scaffolds (fibrin, adipose tissue) or synthetic (collagen, hyaluronic acid) in order to obtain the most effective results.
How are these growth factors and stem cells obtained?
Platelet Rich Plasma Grafting (PRP). Is a technique in which the patient’s blood is drawn from a vein and concentrated by a special centrifuge device, ultimately creating a concentrate of platelets in plasma. This concentrate contains up to 500% of bioactive proteins, along with multiple growth factors, which are essential in inducing and accelerating tissue repair and regeneration. he PRP is injected into specific tissues by using the most advanced tissue guidance with ultrasound. Most of the benefit is seen in the connective tissues, bone, hyaline cartilages and development of new blood vessels necessary for tissue healing.
Bone Marrow Aspirate Concentrate (BMAC)- Stem Cells. This procedure is a more advanced form of regenerative therapy, in which blood is withdrawn from your own bone marrow (Iliac crest) and concentrated with a special device. The concentrate contains .1% Mesenchymal Stem Cells (type of stem cells that repairs cartilage, bone, ligaments, etc.), growth factors and platelets, which are capable of stimulating tissue regeneration to a greater degree than the PRP. The technique is usually performed under local anesthesia with mild intravenous sedation for enhanced comfort.
Adipose Derived Stromal Cells (ADSC) Stem Cells.. Adipose tissue is removed through a small cannula with liposuction, usually under local anesthesia with intravenous sedation. A small amount of adipose tissue is removed (50-100cc) and mesenchymal stem cells (the type of stem cells most capable of musculoskeletal tissue repair) are extracted under sterile technique. The adipose tissue is processed in our state of the art facility and the final preparation contains different type of healing cells, including 5-8% Mesenchymal Stem Cells, which is 500-800% more cells than obtained from BMAC ADSC is our preferred method in patients with more advanced conditions or in situations were other biologic therapies have failed.
Allogeneic Amniotic Tissue Graft refers to amniotic tissues and fluidsobtained from healthy donors (carefully screened with no communicable diseases) during a cesarean section. It contains collagen, growth factors and a very small percentage of live amniotic stem cells. These are mesenchymal stem cells and are more powerful than traditional adult mesenchymal cells. We utilized amniotic grafts in patients that cannot donate their own cells or are unwilling to undergo the graft extraction procedure.
Frequently the above described tissue grafts are enhanced with other products necessary to create a tissue scaffold (three dimensional structure), in order to provide a tissue blueprint for regeneration.
Which Type of Bio-Cellular Regenerative Intervention is Best for Me?
Upon reviewing your medical records and undergoing a complete evaluation, your physician will determine which specific therapy is best for you. For simple cases with minimal tissue damage or degeneration, Biologic Stimulant Therapies may be recommended. When the condition is more advanced, then Platelet Rich Plasma Grafting (PRP), Adipose Derived Stromal Cells (ADSC),Bone Marrow Aspirate Concentrate (BMAC) or Allogeneic Amniotic Tissue Grafts may be a more optimal alternative.
How Many Treatments are Usually Necessary?
The number of treatments is dependent on several factors: type and severity of the damaged tissue, location, nutritional state of the patient, age and genetic factors. Usually with Prolotherapy or PRP, several treatments (usually 1-4), four to six weeks apart, are usually necessary to achieve the desired outcome. With BMAC usually one therapy is performed and if necessary, followed by PRP or Prolotherapy.
When Can I Return to Work or Resume My Usual Activities?
Every patient and treatment is unique and requires specific recommendations. The decision is usually made according to the progress, lack of symptoms and response to therapy. Recovery from the procedure usually takes less than 48 hours. Remember, the regenerative process takes time and usually requires several interventions to achieve the desired goal.
Are There Any Specific Instructions Before or After the Procedure?
With PRP,ADSC and BMAC, all non-steroidal anti-inflammatory medications (aleve, motrin, ibuprofen, etc.) should be stopped for one week prior to and one week after the procedure. According to which specific tissue is treated, certain restrictions will apply. Usually there is localized soreness and discomfort lasting for 24-48 hours. Medications will be prescribed if necessary to alleviate the symptoms. Other instructions will be given which pertains to the specific type of intervention to be performed.
Is the Procedure Covered by My Insurance Plan?
Because most Bio-Cellular Regenerative Interventions are considered (off label) or investigational by insurance carriers, most procedures are not covered. Recommendations for financial arrangements will be available at our centers.
I hope that this little medical humor served its purpose and makes you a more informed patient. Thank you for your interest in our humble institute.( Always a student, frequently a mentor and never an expert. )
Carlos J. Garcia, MD