Spinal Stenosis Surgery Alternatives: Stem Cells or PRP?

By Chris Centeno, MD /

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A few years back, I would never have believed that you could treat spinal stenosis without surgery. Since then, we have been at the forefront of spinal stenosis surgery alternatives through the use of precise platelet and stem cell procedures. How is this possible? Let me explain.

First, if you really want to understand this blog, please watch my video above.

What Is Spinal Stenosis?

Each of the spinal vertebrae (spine bones) have a hole in the middle, which is called the spinal canal. This is where the spinal cord and nerves run. If other structures inside or outside the spinal canal put pressure on these nerves, it’s called spinal stenosis.

What Causes Spinal Stenosis?

The spine bones can become unstable, which means that they can get sloppy and move around too much. This happens because the ligaments and muscles that normally stabilize the spine become loose or atrophied. This motion can cause extra stress on the discs, facet joints, and the ligament inside the spinal canal called the liagamentum flavum. This, in turn, causes these structures to get larger and press on the nerves in the spinal canal. Since these nerves are pain sensitive and power your legs, you can get low back pain as well as weakness or numbness in your legs or feet.

What Are the Classic Symptoms?

The biggest tell-tale sign that you have spinal stenosis is standing intolerance. In these patients, standing for any length of time causes back pain or leg symptoms that get immediately better on sitting. In addition, patients often notice that if they bend forward while walking (like leaning on a shopping cart), they have fewer symptoms.

What Are the Most Common Treatments?

Steroid injections are often used to help reduce swelling around the pinched nerves. The problem here is that these high-dose steroids can damage tissue. In addition, they often only work temporarily to control pain.

Surgery is also an option, and the focus in that case is to remove bone and structure to open up the spinal canal. The biggest issue is that these surgeries are massive and incredibly invasive. These days fusion is often used, and this can lead to adjacent segment disease. To understand that side effect, see my video below:

So are there spinal stenosis surgery alternatives? Let’s explore that idea.

Spinal Stenosis Surgery Alternatives Are All About Fixing the Sloppiness

Remember when I said that spinal stenosis was caused by vertebrae that became sloppy and moved too much, which in-turn wears out the joints, discs, and ligament inside the canal? What if we could nonsurgically tighten down those structures and reduce the sloppiness? Things might actually start to heal. What if we could place healing growth factors around damaged nerves and into damaged facet joints? This is the focus of the Regenexx DDD procedure. Let’s explore that further.

The Regenexx DDD Procedure Is the World’s First Regenerative Spinal Stenosis Surgery Alternative

Four main precise procedures make up our DDD treatment protocol:

Percutaneous Ligamentoplasty—precise ultrasound and fluoroscopically guided injections to tighten loose ligaments and reduce instability and pressure on the spinal canal. This includes the supraspinous, interspinous, and iliolumbar ligaments. Another injection target is often the swollen liagmentum flavum in the spinal canal.

Percutaneous Facet Joint Arthroplasty—precise fluoroscopically guided injections to help reduce swelling and breakdown of facet joints

Percutaneous Biologic Neuromodulation—precise fluoroscopically guided injections to reduce swelling and increase blood supply of spinal nerves

Percutaneous Myoplasty—Precise ultrasound-guided injections into atrophied spinal stabilizing muscles

Notice that due to the “percutaneous” moniker, these are all precise X-ray- or ultrasound-guided injection procedures and that this is not just another surgery.

What Do We Inject?

Since we’ve been perfecting orthobiologics for use around the spine for almost a decade and a half and were the first human beings on earth to inject stem cells into a low back disc, we’ve learned a thing or two and evolved several injectates to perfect this procedure. Our most common ones used include the following:

  • High-dose 3rd- and 4th-generation platelet lysates
  • High-dose 3rd-generation platelet-rich plasma

These are both derived from a simple blood draw, and both are quite different from what you can get in a clinic that uses a simple bedside centrifuge.

Can this procedure be done with stem cells? Yes, but in our experience, most patients respond to far less invasive and less expensive platelet-based procedures.

How Could This Work?

Don’t you need to surgically remove what’s pressing on the nerves? In a few cases yes, but in most cases no. Why? The main culprit causing the symptoms is usually the ligamentum flavum that lives inside the spinal canal. It gets weak and hypertrophied just like all dysfunctional ligaments and tendons do. Knowing how to inject substances that will heal the ligament and make it stronger as well as tighten the ligaments that connect this structure to the back muscles is all that’s needed to gain that extra millimeter or two that’s needed to open up room for the nerves. In addition, remember that pain is a neurochemomechanical phenomenon, meaning it’s as much about mechanical pressure as it is irritated nerves and bad chemicals in the area. Finally, surgery that cuts stuff out weakens the spine and usually sets people up for future problems.

Who Can Perform This Procedure?

First, who can’t perform this procedure? A nurse in a chiropractic office is not skilled enough nor would she be trained enough to perform these exacting and precise image-guided spine procedures. So if a chiropractor, acupuncturist, or naturopath tells you he or she can do this, please run. While an interventional spine doctor could theoretically perform this procedure, he or she would need substantial additional training to understand what is being injected and how, as none of these procedures are part of the traditional training for these doctors. So if an interventional spine doctor says that he or she uses PRP, it’s very, very unlikely that this doctor understands what is being injected here, and how.

The upshot? I have been blown away these past few years that it’s possible to effectively treat spinal stenosis without a surgical decompression. There are reasons this works, which are explained in the video and above. So if you have spinal stenosis, try as hard as you can to avoid invasive surgery and harmful steroid injections!

Category: Spine

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26 thoughts on “Spinal Stenosis Surgery Alternatives: Stem Cells or PRP?

  1. Judy Ellman

    Who does this procedure in south Florida

    1. Regenexx Team

      Hi Judy,
      Dr. Bashir, at Ocyon in Aventura, Florida. Here’s the website: https://ocyonregenerative.com/

  2. Karen Savia

    Who is the best in administering these procedures in the Northern Va/ Washington Metropolitan area? Thank you!

    1. Chris Centeno Post author

      Mayo Freidlis and his group: https://regenexx.com/stemcell-arts-virginia/

  3. Romey Willis

    who does this in austin, tx.?

    1. Regenexx Team

      Hi Romey,
      No one in Austin, but we have 2 Texas locations approximately equidistant to Austin. Please submit the Candidate form here: http://www.regenexx.com or call 855 622 7838 for assistance in finding the best location for your needs.

  4. Polly

    Who does it in Orange County, California?

    1. Regenexx Team

      Hi Polly,
      We have a Regenexx Clinic in Beverly Hills. Please submit the “Am I a Candidate” form here: Please see: https://regenexx.com/los-angeles/

  5. Brian Kight

    Who can perform these procedures in Ohio!? Thank you!

    1. Regenexx Team

      Hi Brian,
      We have 2 locations in Ohio. Please call 855 622 7838 to determine which would be best for your needs.

  6. Glenda C. Beall

    Who is a legitimate business where I can get stem cell for lumbar stenosis in Atlanta?

    1. Regenexx Team

      Hi Glenda,
      The very best in Atlanta is our Atlanta Regenexx Provider, Dr. Chris Williams. Please see: https://regenexx.com/interventional-orthopedics-of-atlanta/

  7. miriam

    Is there anyone doing this in NY for spinal stenosis, spondylisthesis?

    1. Regenexx Team

      Hi Miriam,
      Please call 855 622 7838, and our team will help you find the best location for your issue.

  8. Elaine Fossler

    PRP shots for spinal Stenosis — where is the closest doctor/clinic to Houston Texas?

    1. Regenexx Team

      Hi Elaine,
      Our Houston Area Regenexx Clinic is Texas is here: https://www.texasinterventional.com/

  9. Larry Snyder

    Have been diagnosed with Spinal Stenosis. From what I’ve read thusfar, if it’s caught “early enough”, physical therapy may be the best step toward a cure. However, if you have had it for almost a year, it may be to late for that, and stem cell injections may be the only way out. Please comment on this…is this statement true? And, if so, what are the costs for injections? And….are there any other methods to treat the stenosis?

    1. Regenexx Team

      Hi Larry,
      As it states in the Blog, stem cells are not usually needed to treat Spinal Stenosis so ,yes, other treatment using precise image guided injections of specific platelet procedures made from your own blood are most often used, but it depends on the individual case. Spinal Stenosis is a result of Spinal Instability so the ability to treat the stabilizing ligaments, the facet joints, the nerves and the ligament inside the spinal canal called the liagamentum flavum are needed. However, these are injections that very few physicians have the training to do properly, nor the ability to customize what needs to be injected for the maximum outcome. Please see: https://regenexx.com/blog/orthopedic-stem-cell-treatment/ and https://regenexx.com/blog/regenexx-flexible-lab-platform/. If you’d like to see if we can help in your case, please submit the “Are you a Regenexx Candidate” here: https://regenexx.com/conditions-treated/spine/ Cost depends on what’s needed in each individual case.

  10. Terri Talas

    Hi Chris, I am scheduled for PRP for chronic low back issues with Dr. Musman in Vermont. The more I read and research, it seems that PRP has to be repeated more than once as it does not last more than a few months compared to stem cell treatments. Also, I’ve learned that a center in Massachusetts combines PRP and Stem cells together because according to them the stem cells provide longer relief (up to 5 years or more). Vermont did not offer me this option and instead indicated I will have 15 to 20 PRP injections into my nerves, ligaments, facet joints etc. Could you clarify if Regenexx offers a combined PRP and Stem Cell treatment?
    Thank you, Terri

    1. Regenexx Team

      Hi Terri,
      All Regenexx stem cell procedures are a combination of PRP (but stronger and and customized to the patient) and the patient’s bone marrow stem cells. Stem cells, however, are appropriate for only a small percentage of back issues. What is the diagnosis being treated? Please see: https://regenexx.com/blog/should-you-get-your-disc-injected-with-stem-cells/ and https://regenexx.com/blog/regenexx-flexible-lab-platform/

  11. Chris Doyle

    Who does these injections in New York City or in New Jersey ?

    1. Regenexx Team

      Hi Chris,
      No one in NYC or New Jersey at the moment. For assistance in finding the best location for your needs, please give us a call at 855 622 7838.

  12. Nancy

    How long after PRP will I begin to feel relief from spinal stenosis?

    1. Regenexx Team

      Hi Nancy,
      It depends on the individual case.

  13. Sam

    I recently suffered from a huge disc herniation L4-L5, that caused almost 90% spinal stenosis, luckily I have no neurological deficits, just pain radiating down both thighs, do you think there is a good chance I can benefit from the PRP injections.

    1. Chris Centeno, MD Post author

      Fluoroscopically guided Platelet lysate injections are what we use for herniated discs, see https://regenexx.com/blog/epidural-steroid-injections/

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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