I love the creative ways patients find to let us know that they’re doing better. This last week, I received this great shot from Dr. Pitts who had treated Agnes, a patient who had significant back pain with hiking. Here she is, having just climbed Colorado’s Mt. Elbert at 14,433 feet! So how did we help her avoid back surgery?
Agnes had an annular tear on her MRI. What is this? The low-back discs have two main parts. The inner gel is called the nucleus, and the outer covering is known as the annulus. The latter has many strong fibrous layers that are constructed like an onion. It’s possible to tear the fibers of the annulus, and this can cause pain. It’s also something that can happen with wear and tear and likely doesn’t cause pain. It’s thought that these tears in the annulus lead to degeneration of the disc over time.
Given that we were the first clinic on earth to treat damaged low-back discs by injecting stem cells, we’ve learned a thing or two through the last 12 years. While it’s easy enough to inject the disc, this isn’t always the answer. First, it’s more invasive that just injecting other structures, like the area around the irritated nerves (epidural), the facet joints, or the ligaments. Second, if the patient can be made better without injecting the disc, why take the additional risks of injecting that structure? These risks include the possibility of damaging the disc and the rare possibility of a disc infection known as discitis.
What Did Dr. Pitts Do for Agnes?
Agnes was injured in a car crash. While her MRI showed an annular tear, her exam looked like she may have injured her facet joints and ligaments. The facets are small joints that help guide the movement of each individual low-back disc along with the ligaments. Dr. Pitts also suspected that these ligaments had been injured, and this additional motion allowed by now-loose ligaments may be irritating the low-back spinal nerves. All of this was certainly enough to give her back pain when hiking.Even though injecting the disc with platelets or stem cells can be very helpful, Dr. Pitts knew that there was a significant chance we could help Agnes without injecting inside the disc. So after a careful exam and review of her imaging, he chose to inject HD-PRP and HD-platelet lysate (HD=high dose) into her injured facet joints, around her irritated nerves, and into the damaged ligaments. How did she do? This is the note she sent Dr. Pitts:
The upshot? We can’t help every patient, but the wide array of proprietary technologies that we have available to us allows our Regenexx providers to treat many different spinal problems. We’re glad that we helped Agnes climb and conquer her personal summit! Hopefully, now she can put back pain with hiking behind her!