Are They Really Injecting Your Disc?
I often write about what I experience on a day-to-day basis. One of the more interesting scams out there is a proliferation of ex-US “stem cell” clinics that are telling patients that they are injecting intervertebral discs when, in fact, most are never coming close to placing cells in the disc. Let’s dive into this today.
What Is an Intradiscal Stem Cell Injection?
The disc is a shock absorber that lives between the vertebrae. It can degenerate, lose height, and allow sloppy movement between the vertebrae. The disc can also bulge and irritate spinal nerves. This condition is called DDD, which is short for degenerative disc disease, and can cause the back joints to get arthritic.
The idea behind injecting stem cells into degenerated discs is that they will somehow regrow or rejuvenate the disc. While animal models have shown this feat to be feasible, human evidence remains very sparse. Why? There are stark differences between the discs of rabbits and people. This is regardless of the stem cell type injected.
What can be achieved? As the first human on earth to inject stem cells into a disc in 2005/6, I have seen evidence of annular repair and resolution of disc bulges with specific cell types and placement strategies. However, this is still a far cry from growing someone a new disc in situ.
Despite the lack of any compelling evidence that injecting stem cells into a human disc can regrow a new one, many patients have seized on the idea that they need to have their discs injected with stem cells. While some of these patients could benefit from a properly performed disc stem cell procedure, this demand has shaped how stem cell clinics both in and outside the US have marketed to patients. In general, after speaking with countless patients who have received these sales pitches, we have clinics that cannot perform these sophisticated intradiscal stem cell injections, claiming that they offer these procedures to gain a customer.
This week, I spoke to one such patient who cited three Banana Republic stem cell clinics, who all claimed that they could inject his discs. Hence, I wanted to explore this thesis for him and the countless patients being fooled every day.
The Banana Republic Licensure Problem
When it comes to sophisticated imaged guided injections and percutaneous device placement, no country on earth approaches the U.S. for the number of physicians with advanced training who have these skills. The places where these skills are rare include Europe, Asia, Mexico, Central America, and South America. This is a big problem for accurately placing stem cells via image guidance into the spine if your clinic is outside this country.
This problem is surmountable in the Caribbean as US physicians can get licensed to practice in the islands. Despite this, few clinics will pay the fees demanded by US doctors with this skill set, but at least it’s doable. This is why we placed our advanced, culture-expanded stem cell site in Grand Cayman. Our highly trained US physicians can practice there.
Importing better-trained US physicians won’t work in Latin America. Why? Unlike the Caribbean, where there is a long tradition of US doctors practicing part-time in the islands, these Latin American countries have their own medical education systems. The “local yocal” doctors know that any US-trained physician who opens a practice will quickly outcompete any local offering. Hence, these countries don’t allow US physicians to easily obtain licenses.
This is why, when you look at Latin American stem cell sites, you will rarely see physicians listed, and when you do, they are usually not the right types of physicians trained to do sophisticated spine procedures. They are also not likely to be US physicians. Let’s take a few examples.
A Few Examples
The patient above told me he was planning to go to a specific Tijuana clinic, a Panama clinic, or a Columbia clinic to get his disc injected. I laughed. Why? Let’s dig in here and look at these offerings.
Tijuana
No physicians are listed on this website.
Panama
This clinic doesn’t even list spinal injections as a specialty. The focus is on IV “stem cell” injections. No physicians are listed at all.
Columbia
Here, we see several physicians listed, but as we go through the list, none of them are the right type of physician to perform the intradiscal procedure this patient wants:
- Sports physician 1- Family practice sports with ultrasound guidance skills only. You can’t inject the disc using ultrasound.
- Neurosurgeon – This specialty has no interventional spine training. What US courses did this physician take to learn this skill? None are listed, which is odd, as the sports doctor listed above has a specific US ultrasound course listed.
- Physician 3- No qualifications listed; specializes in herbal medicine, so not qualified.
- Physician 4- Not qualified; looks like an endocrinologist.
- Physician 5- General surgeon, not qualified.
- Physician 6- Family medicine, not qualified.
- Sports physician 2- No spine training.
So, of these doctors, we have only one who could be qualified to inject the spine with additional training (the neurosurgeon), but no outside training is listed.
Why can’t neurosurgeons inject discs? For example, when I ran the Interventional Orthobiologics Foundation, I was asked to review the qualifications of a neurosurgeon who wanted to take a stem cell disc injection course we offered. I called him and asked if he had ever learned that skill in his residency or fellowship. He said, “No, but how hard could it be?” The answer is plenty hard. I told him that he needed to get that training from one of several US-based organizations and, once certified, to call me back. In the meantime, he was denied access to the course.
It should be noted that, since the publication of this blog, this clinic reached out via Linkedin and has stated that this neurosurgeon is injecting discs. I have yet to hear which additional training was performed, but if I do, I will update the blog.
What Type of Physician Should Be Listed?
Interventional pain management is the medical specialty with extensive training in safely and accurately injecting discs using imaging guidance. In the US, these days, IPM physicians are trained in fellowship programs after a PMR, Anesthesia, or Sports Medicine residency. These fellowship programs didn’t exist back in the day, so the gold standard of fluoroscopy-guided disc or spine injection training was the International Spinal Injection Society (ISIS). Because of the other ISIS, they changed their name to SIS and then now IPSIS.
However, even here, you need to be careful. There are significant differences in using orthobiologics like stem cells in discs versus performing discography (the disc injection technique taught in IPM fellowships). Hence, you need to find an IPM physician with additional training in orthobiologic disc injections.
Why Aren’t Physicians Listed?
Two of the three clinics didn’t list the physicians or their qualifications. Why? These clinics are run like businesses. In all businesses, service delivery costs are subtracted from profit. The more highly trained the specialist, the more pay that doctor will command. Hence, a rotating crew of local physicians is much cheaper and doesn’t create problems for patients who might want doctor A or B listed on a website. So, it’s more profitable to hide the identities and training of the local physicians you hire.
Why Can’t a Disc Be Injected Blind or With Ultrasound?
What’s nuts is that many clinics tell patients they are injecting their discs but never get anywhere near it. To understand this, we must review what’s involved in injecting the intervertebral disc. Doing that in writing with illustrations is tough, so I prepared a YouTube video below that does it far better:
As you can see above, if a clinic tells you that they are using ultrasound to inject your disc or that they will do it blind without guidance, the likelihood that they are placing anything in or even near the disc is slim.
What Else Are They Not Being Honest About?
If a clinic is claiming to inject your disc with unqualified providers or using ultrasound or blind, now you can see that they’re not being honest. So, if they’re not honest about this issue, what else are they neglecting to tell you?
The upshot? As you can see, injecting the disc is a big deal that can’t be done by just any physician without specific training. In addition, it can’t be safely done using ultrasound or blind without guidance. Hence, if you find a clinic that claims to be able to do this, please do your homework or share this blog so that they can see if the claim holds water.
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NOTE: This blog post provides general information to help the reader better understand regenerative medicine, musculoskeletal health, and related subjects. All content provided in this blog, website, or any linked materials, including text, graphics, images, patient profiles, outcomes, and information, are not intended and should not be considered or used as a substitute for medical advice, diagnosis, or treatment. Please always consult with a professional and certified healthcare provider to discuss if a treatment is right for you.
