Dramatic Improvement in Severely Degenerated Cervical Joint Without Surgery

By Chris Centeno, MD /

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I’ve spent the last 12 years staring at MRIs before and after orthopedic stem cell treatments. I’ve seen some incredible things in many conditions and some MRIs that didn’t change. This past week, as I reviewed the MRI of a patient with a severely degenerated cervical facet joint that we had treated at our licensed facility in Grand Cayman, I gasped. The results were truly remarkable.

Unidentified Instability Leads to Severely Degenerated Cervical Joint: C2-C3 Facet Joint

I’ve discussed before how joints can become unstable (e.g., craniocervical instability, shoulder instability, and hip instability) and havoc can ensue when it goes unnoticed and untreated. This is exactly what happened to the patient whose case study I present in the video above. The patient had been involved in a car accident and experienced a subtle instability at her C2–C3 level in her upper spine. This was not only left untreated but also unidentified. In addition, the answer to her pain, unfortunately, was multiple high-dose corticosteroid injections, and by the time she made her way to me, these injections had likely caused her severely degenerated cervical joint, called DJD (degenerative joint diesase), at the C2–C3 left facet joint, with hypertrophy. This then led to severe foraminal stenosis, a narrowing of the space the spinal nerves run through. This larger facet joint then placed pressure on the covering the spinal cord called the dura.

High-Dose Steroid Injections and/or Surgery Are Bad News

Sure, high-dose steroids, commonly injected into joints to relieve pain, are powerful drugs that may temporarily reduce swelling. Their anti-inflammatory, pain-reducing effects may last for a few weeks or months, and this is why patients feel so good after they get a steroid shot. However, the pain and inflammation returns when the steroid “magic” wears off, often sending patients rushing back for another steroid fix. Why is this a problem? Why are steroids such bad news?

First, pain relief usually diminishes with repeated steroid injections. Research has also linked high-dose steroid injections to many side effects. Their link to cartilage loss is a big one with one recent study showing progressive long-term cartilage loss and pain relief for arthritis no better than with a placebo. Steroids’ effects on bone are also a huge concern as studies have shown associations between steroids and fractures as well as bone loss.

Surgery also would have been bad news. For severe DJD, in orthopedic surgery, cervical fusion would have likely been the last-resort step here. Luckily my patient didn’t get that far. A cervical fusion involves installing hardware, such as plates and screws, to bolt the vertebrae together, rendering them immovable and oftentimes disrupting the normal curves throughout the entire spinal column.

C2–C3 Treatment Without Steroids or Surgery

We initially treated this patient with high-dose platelet rich plasma, which provided good relief of her symptoms; however, because of the severity of her facet joint arthritis, it wouldn’t last. Realizing our culture-expanded mesenchymal stem cell (MSC) treatments were going to be the best solution, in this case, we injected 1 million culture-expanded MSCs and 1 ml platelet lysate at our licensed site in Grand Cayman. This dosage is about a thousand times more MSCs than you could ever inject into the joint within a US-based treatment. We also treated her local ligaments (cervical supraspinous and interspinous ligaments).

In the video, you will see a dramatic before and after MRIs of the left C2–3 facet joint. First, to look at the before picture, let’s first review the image below. Notice that the facet joint (yellow arrow) is bigger and darker than the opposite side. The darkness means the bone is dying and stressed. The increased size is called hypertrophy. The blue arrow points to the enlarged joint putting pressure on the dura. The red arrow points to the narrowed foramen.

The after image, five months following her treatment (see video), shows her hypertrophy is mostly gone and the bone now appears normal. The left C2–C3 foraminal stenosis and the pressure on the thecal sac, the covering of the spinal cord, has also improved. There was likely still a small bit of fusion in the joint, but considering this was an end-stage joint, this is understandable. Clinically, the patient reports a 60% improvement in her pain.

The upshot? Our advanced stem cell treatments never cease to amaze me. This case, in particular, shows how powerful these procedures can be. Think about it. No surgery, no hardware, and no destruction of the tissues getting all of that done. Just a small needle placed in the right spot to inject the right stuff.

Culture-expanded MSCs are not FDA approved for use in the U.S. but are subject to an existing phase FDA 2 clinical trial. This patient was treated in Grand Cayman, which allows culture-expanded MSCs as the practice of medicine.

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11 thoughts on “Dramatic Improvement in Severely Degenerated Cervical Joint Without Surgery

  1. Dane

    Just a couple days ago one of my coworkers was rushed into orthopedic surgery for bulging cervical discs and stenosis… he’s getting a fusion and multi-level artificial discs. While it’s possible that his condition was too advanced to be helped by MSCs, we’ll never know because they rushed him into surgery. I feel pretty bad for him, but hope he’s one of the lucky ones who benefit from these procedures, even though the research suggests otherwise.

    1. Regenexx Team Post author

      Dane,
      The longterm outcomes for cervical disc replacement and fusions are not good, but we hope with you! https://regenexx.com/blog/cervical-disc-replacement-complications/ and https://regenexx.com/blog/disc-replacement-side-effects/

      1. Dane

        What I found truly appalling about the situation is that they were originally planning to fuse the whole neck, but only use the cervical replacements if approved by insurance. The replacements were approved, but if they weren’t he would have likely had the full fusion. He told me his surgeon informed him about adjacent segment disease, which is why he wanted to go with the disc replacements, but I remember reading in this blog that the artificial discs move so abnormally they can still cause degeneration above and below.

        I got the impression that his surgeon considered this an emergency that needed to be operated on right away, which may very well be the case. I didn’t get the impression that there was any attempt at conservative management, it was just “You need surgery right away or you’ll have permanent damage to your spine!”. Definitely possible, and maybe in their judgement the short term intervention is worth the risk of long term consequences. As patients we’re told we need to believe what our doctors tell us, which is certainly true the vast majority of the time, but these grim realities in orthopedics raise so many doubts.

  2. chris

    You’ve mentioned before that you end up recommending surgery for some cervical patients(like you did for an ACL patient in a recent blog). At what point will someone not respond to culture-expanded MSCs.

    1. Regenexx Team Post author

      chris,
      Complex question with a complex answer. However, to simplify, patients who have severe stenosis where the bone is actively and severely compressing nerves and there is no way to get the bone to recede are not candidates for these procedures.

  3. Mark

    Any luck/good results using MSCs for severely degenerated/arthritic cervical facet joints where the discs are severely degenerated and lost most of their height?
    I have gone a few rounds of PRP and Platelet lysate (Regenexx Doc. near D.C.) in the spinal canal, facet joints and surrounding structures,helped with pain but still having all the cracking,popping and joints locking up.

    1. Regenexx Team Post author

      Mark,
      We have not seen any evidence that any stem cell therapy can add lost disc height at this point. The best practice would be treating the lax ligaments.

  4. Becky Geisel

    Can stem cells help dissolve bone spurs in the cervical spine that is causing Radiculopathy in right arm

  5. Becky Geisel

    Thanks for the reply. Yesterday, I saw a “non surgical” orthopedist who has referred me to a surgeon. Not what I wanted to hear. Apparently I am displaying signs of cervical myelopathy. I have an appointment with your Atlanta based doctor in a few weeks and hope I can skip the surgery. I am a very active (until recently) 57 year old who avoids surgery like the plague.

    1. Regenexx Team

      Hi Becky,
      Hoping with you!

Chris Centeno, MD

Regenexx Founder

Chris Centeno, MD is a specialist in regenerative medicine and the new field of Interventional Orthopedics. Centeno pioneered orthopedic stem cell procedures in 2005 and is responsible for a large amount of the published research on stem cell use for orthopedic applications.
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