Low Back Stem Cell Injection: How to Tell a Scam from the Real Deal

By Chris Centeno, MD /

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low back stem cell injection

As the first human being to inject stem cells into the low back discs way back in 2006, I often get asked by medical experts to look at patient films. Sometimes the planned low back stem cell injection looks real, but oftentimes it's a scam. I'd like to share with you a message I got from a cardiologist friend to teach you how to avoid being the victim of a low back stem cell injection scam. 

Low Back Stem Cell Injection

Stem cells can be useful for certain types of back problems and a complete waste of time for others. What we learned over a decade and a half was that if you have a torn disc, a same-day bone marrow stem cell procedure, directly into the disc using X-ray guidance, can be helpful. If you have a bulging disc, a cultured stem cell injection procedure into the disc bulge, again using X-ray guidance, can help reduce the size of that bulge. However, for garden-variety degenerative disc disease, a stem cell procedure into the disc is not effective and, in fact, a platelet-based procedure is more helpful. To learn more about low back stem cell injection, please see my video below:

To learn about how best to treat degenerative disc disease, please see my video below:

The Message from the Cardiologist That Freaked Me Out

I've known this cardiologist for years, and out of the blue I was sent this message:

"I have a friend that lives in Seattle…She has very symptomatic lumbar spine arthritis without obvious disc She went to (a) Seattle Stem Cell Clinic and had 50 cc liposuction and had some given IV only, and rest put into culture waiting almost 3 months to grow enough to inject as their treatment strategy. They lost their lead physician and the one supposed to inject her back on the 15th is a family practice doc who told her she wasn't sure where to put the cells I learned this today and asked her to delay that plan Would you please look at her films and decide what her best course would be? I sent her to your website and gave her a sketch of your experience and reputation and she would be grateful to hear your opinion."

Unpacking the Message: This Is So Wrong on So Many Levels

The first thing we see in the message is that the clinic drew fat and then sent that someplace to be cultured to grow larger numbers of cells. This is clearly illegal in that to do this, the company processing the cells would have to have an active FDA approval in place. I had exposed this type of illegal cell processing before involving Cell Surgical Network, so my first search was to see if this physician was a member of that organization. Since she is listed on the CSN website, and we now know that the FDA is suing Cell Surgical Network due to not having an FDA approval in place, this confirms everything we need to know about the legality of shipping cells to be grown. 

How does this impact the patient? Once the FDA wins its lawsuit, your cells are gone forever. Meaning, one of the advantages of culture expansion is the ability to save cells for future use. However, once those cells are declared an illegal drug product, your cells can't ever be used. 

Next, the physician that runs this clinic is a family doctor whose focus is in aesthetics. So it makes sense that the patient relates that "the one supposed to inject her back on the 15th is a family practice doc who told her she wasn't sure where to put the cells." This is the statement that I wanted to unpack so that you can determine what's good spinal regenerative medical care and what's not. Let's dive in further on that concept.

What Could Be Injected in a Low Back?

So where could you inject the cells in the low back? There are lots of options:

1. Intervertebral discs—inside the disc (nucleus pulposus) or into the outer covering (annulus)

2. Facet joints

3. Ligaments (there are many different options here)

4. Stabilizing muscles (multifidus)

5. Superficial muscle trigger points

6. Around irritated nerves (epidural)

7. SI joint (inside the joint or into the surrounding ligaments)

8. Thoracodorsal fascia

So there are many choices where the cells could go. In addition, learning how to place cells in all eight places is very difficult. For example, if you have significant additional training in interventional spine injections, you can use fluoroscopy (real-time X-ray) to place the cells into the disc, facet joint, SI joint, or epidural space. However, you likely have never been trained to place them into muscles, ligaments, or fascia. If you have been trained to place them into muscles, ligaments, and fascia using ultrasound guidance, it's unlikely that you have the education and experience to place them into the disc, facet joint, SI joint, and epidural space. Do you see the dilemma here? The average interventional spine doctor only knows how to place cells in about half of the spots, and the average doctor who took a course can only place them in about half the other spots. 

This gets even worse, in that we have many physicians who can only place them in one spot, which is the superficial muscles. This is called a trigger-point injection, and this is commonly seen with plastic surgeons and family doctors. So these physicians will only get them in one of eight possible places where they may do some good. This could be why they gave this patient an IV of stem cells, in that the doctor, who doesn't know what she doesn't know, believes that will make up for the lack of accurately placing the cells in all of these other areas. The problem? Stem cells injected IV undergo a pulmonary first pass effect with 97% ending up in the lungs. In addition, since many of these places where the cells could go have a poor blood supply, there is no way for them to get there without direct placement.

"The Real Deal" vs. "The Scam"

So a real low back stem cell injection will be performed by a highly trained interventional spine physician who can place the cells deep into the areas of the spine that require fluoroscopy guidance and has additional training in how to use ultrasound to place cells into the muscles, ligaments, and fascia. These physicians are few and far between as I would estimate that we, at most, have 200 in the U.S. right now. If there is a Regenexx doctor certified by our organization for the spine, you can rest assured he or she knows how to do both. If not, then these are some questions to ask:

1. Is the doctor performing the injection trained in interventional spine, and does he or she use real-time X-ray guidance (fluoroscopy)?

2. Does that same doctor use ultrasound to be able to place cells into the muscles, ligaments, and fascia?

If the answer to either one is "No" or you're told that the doctor will inject the cells into the areas that hurt (muscle trigger points) and that the IV will take care of the rest, then find another doctor!

The upshot? As you can see, low back stem cell injection requires quite a bit of physician skill. There are few doctors who can pull this procedure off right now at a high level. However, I hope I've given you a way to tell a scam from someone who has the skill, knowledge, and expertise to do good work! 

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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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