Nerve Regeneration – The Future Doesn’t Involve Surgery
Regenexx first began treating injured nerves using orthobiologics delivered via ultrasound guidance in 2012. However, the concept that a precise injection can help nerve regeneration was so revolutionary that we were reluctant to really shout it from the roof tops until we had enough experience under our belt to be sure that it was working. After a few years of seeing nerve injury patients consistently respond to this therapy, I think it’s time to share some of our results and finally declare our confidence in this new procedure that may change how doctors treat nerve injury and entrapment, now and in the future.
Regenexx History with Nerve Regeneration
Our history with the nerve regeneration procedure begins with a different take on platelet rich plasma (PRP), which is the concentration of platelets from a blood sample. Unlike almost all clinics that use PRP, we’ve always had another platelet-based treatment available called platelet lysate (PL). Unlike PRP which can be pro-inflammatory, PL is anti-inflammatory. As industry leaders in regenerative medicine and related research, we’ve noted that this growth factor cocktail works particularly well around nerves. As a result, we’ve been using PL in the epidural (spinal column) space since around 2007 with great results, mostly for patients with sciatica (radiculopathy). As a result, our many successes with PL have driven us to perform the lab research necessary to create successively more powerful versions of PL (we’re currently on our 4th generation version).What is PL and why is it so special? Platelet lysate is made up of the healing growth factors isolated from platelets and resuspended in a growth factor and cytokine rich serum. As discussed above, we’ve been perfecting how to make PL for many years, regularly increasing its growth factor content beyond the simple PLs we first used back in 2007 (which is essentially what some other doctors are just beginning to use).
How Can Platelet Lysate Injections Help Regenerate Nerves?A critical part of the nerve regeneration procedure is precise ultrasound guided hydrodissection. This involves visualizing the nerve under ultrasound guidance and using a small needle to inject small volumes of PL around the nerve. Effectively, the doctor is breaking up scar tissue around various parts of the nerve and freeing it up. This can be critical, as many times nerve entrapments and trauma involve scarring around the nerve that compress the structure. Think of a garden hose and how the water flows through it. A nerve is a similar thing in that it transports nutrients down it’s length. If you step on the garden hose, less water comes out the end, just like a nerve that’s entrapped and scarred, with less nutrients making their way down the nerve. Hydrodissection is like releasing that pressure on the garden hose.
Outside of the mechanical effects of breaking up scar tissue, we believe the growth factors in PL can help nerve function. One of those natural compounds is called vascular endothelial growth factor or VEGF and is responsible for causing the body to create new blood vessels. Nerves have a blood supply like any other tissue and much of that lives on the outside of the nerve. When nerves have pressure placed on them, that blood supply can be cut off, reducing oxygen to the nerve. So creating new blood vessels around nerves may be important in nerve regeneration.
Why Patients Want to Avoid Nerve Surgery Whenever Possible
Surgery to get rid of nerve entrapment is generally not a good idea. I can’t tell you how many patients we’ve seen through the years who have gone through these surgeries with no results, or who have developed new problems related to the surgery. In fact, research has shown that one of the world’s most common nerve entrapment release surgeries, Carpal Tunnel Release, destabilizes the bones of the wrist, due to the surgery cutting a critical ligament that is required for wrist stability.
Trying to repair nerves by cutting them and splicing them back together with micro-surgery is notoriously difficult. Nerves are incredibly complex structures, so getting this surgery just right is hit or miss. This is why the better option is to free up some space around the nerve and give growth factors the opportunity to help the nerve accomplish it’s own regeneration.
Clinical Results Speak for Themselves
We’ve seen Regenexx Procedures time and time again get rid of carpal tunnel syndrome (entrapment of the median nerve at the wrist) without surgery. We’ve observed it help a patient regain radial nerve function. We’ve also witnessed it treat ulnar nerve encampments at the elbow, femoral nerve entrapment at the thigh, as well as tarsal tunnel at the ankle. All through a needle and without the need for invasive surgery.
Case in Point
To give you a better sense of how revolutionary this new procedure can be, I’d like to highlight a recent nerve regeneration patient treated by Dr. Pitts in our Colorado clinic. MS is a 57 year old male who presented to our clinic after a fall from a ladder, sustaining a fracture of his left humerus (upper arm bone). With this injury he also injured the radial nerve (nerve that gives signal to the muscle that causes wrist extension and sensation to the back of the hand). He had surgery to repair the fracture, but the radial nerve was severely injured so he was left with “radial nerve palsy”, meaning that the muscles that the nerve supplied no longer worked well. He was unable to move his fingers and wrist in extension and had numbness and burning pain in the back of the hand. The surgeon offered no physical therapy and informed him that it was unlikely that he would return to playing golf, one of his life long passions. This is because nerves heal very slowly and typically can take 1-2 years to return minimal function back to muscles.
We sent him for nerve conduction tests (NCS/EMG), prescribed specific nerve medication to help with his pain, hand therapy and bracing to prevent wrist contracture (when the joint becomes stuck in a nonfunctional position). These are all the things his surgeon could have offered immediately, but didn’t. Regrettably, the nerve conduction studies showed a damaged radial nerve. At 6 weeks out from his injury we treated him with the new Regenexx procedure for nerve regeneration (hydrodissection of the radial nerve with our fourth generation PL). Within 2 weeks of the first procedure he began noticing an increase in finger movement. He ultimately received 4 treatments over 6 months and below is his update at 9 months after his initial injury:
“I do not believe my recovery is a miracle! I am convinced it is the result of sound medical science and skilled treatment. My orthopedic surgeon and neurologist gave me little chance of resuming playing golf, due to my radial nerve palsy, emanating from a fractured left humerus. The surgery to repair this injury required 9 screws and a plate. My drooping left wrist and lack of any sort of fine motor skills with my hand were evidence of that. Now, nine plus months after injury and seven plus months after beginning treatment, I now have 95% use of my wrist and 85%+ use of my hand. My key indicator with regard to re-establishing my coordination is my golf handicap. My handicap has grown from 3.8 to 4.9 and my low score post injury is 75 (twice), 3 over par. My best the previous year was even par 72 (twice). Golf is an extreme hand-eye coordination sport and I believe a good indicator of the level of recovery for my dexterity, strength and fine motor skills…I believe the nerve hydrodissection in four treatments has produced remarkable results. Progress has now slowed, but is still proceeding.”
Coincidentally, this week we received another update from the patient, who is now 12 months post injury:
“Other than mild stiffness, my hand is about 90-95% of pre-accident condition. Fabulous!”
We also repeated the nerve studies (NCS/EMG) and these showed objective and marked improvement of the nerve’s function.
The upshot? Nerve regeneration through precise guidance is revolutionary. We’ve seen enough great results with this procedure and we feel comfortable letting more patients know it’s available. There’s nothing quite as satisfying as seeing a patient who can’t move muscles because of a nerve injury, regain those capabilities as a result of what you were able to do as a physician. This is doubly so when they told you in medical school that things like this were impossible! At least my medical school dean was smart enough to also tell us, “about half of what we’re teaching you will be declared to be wrong at some point in your career”.
NOTE: Our clinical focus is on helping nerves that have been injured or become entrapped. Nerves that are cut in half with large gaps are likely too severe for this procedure.