I am now officially bombarded with so much information sent to me about clinics fraudulently advertising fake stem cell treatments that I can’t keep up. Today’s entry is a Michigan chiropractic clinic that claimed that it’s injecting stem cells into discs but isn’t injecting any stem cells into any discs. This will be a great example to teach patients how to tell the quality of stem cell therapy for degenerative disc disease.
Michigan Integrative Health
On LinkedIn, I got this message from a trained interventional pain physician about Michigan Integrative Health:
“I would like to bring your attention to the above practice. a chiropractor obviously…one of his ex-NPs interviewed with me for a job. they stick placental products in paraspinal muscles and call it intradiscal stem cells, charging patients for intradiscal stem cells! no C arm in the facility, claiming to use ultrasound to perform intradiscal injections! ..I inherited a patient with critical C spine stenosis and myelopathy from their practice, they were doing IM placental…for > 6 months meanwhile the patient is developing cord myelomalacia and worsening of myelopathy symptoms. I sent him to a Neurosurgeon who operated on him the same night I saw him.”
This piqued my interest as I have seen this bait and switch before in the area around my clinic. Chiropractic clinics claiming that they are performing stem cell therapy for degenerative disc disease using umbilical cord “stem cells” but in fact are only injecting the muscles around the spine. Basically, ridiculously expensive trigger point injections that never get close to the disc.
What is an Intradiscal Injection?
All of the basic science research to date plus early clinical studies on stem cell therapy for degenerative disc disease have used a direct injection of stem cells into the disc itself, what doctors call an “intradiscal” injection (2). We have published two papers on actual intradiscal stem cell injections (3,4). So how is this done?
The doctor uses a c-arm fluoroscopy (real-time x-ray) imaging to image the disc space. He or she then directs a specialized needle into the disc using a pathway that travels under the exiting spinal nerve, Once the disc is entered, the doctor injects radiographic contrast dye to ensure that the needle is in the right spot (1). This is VERY different than injecting spinal muscles, which is what’s described above. How different? Check out my animated GIF below:
How hard is this? Only specialist physicians perform this procedure and it takes a newbie physician specialist about a year to get competent. Performing this procedure incorrectly means injuring the exiting spinal nerve or causing a spinal cord injury. To get an idea of what this looks like in the OR, check out my YouTube video below:
Can you use ultrasound to do this? No, there is no way to see the discs. In addition, all Michigan Integrative Health has is a Nurse Practitioner, so even injecting the disc would place his or her nursing license at risk.
What Does Michigan Integrative Health Offer?
My specialist physician friend above stated that Michigan Integrative Health was claiming to inject stem cells into discs (intradiscal). Their web-site also suggested that as well. Here’s what it says, “The Wave of the Future: Regenerative Medicine with Stem cell care…Stems cells…reinvigorate the body’s own cells, which go dormant in a dehydrated disc, and induce the dysfunctional cells to begin working again.”
However, to confirm I called the office. I clearly explained to two different office people that I wanted a disc stem cell injection and I was told they did that. I then asked how. I was told usually blind without guidance (not possible, see above) and then that they sometimes used ultrasound (also not possible, see above). I finally asked to speak to Dr. Picard, the chiropractor who runs the clinic and he eventually leveled with me that they don’t actually inject the disc. Hence, had I not insisted that I speak with the clinic owner and had I signed up for stem cell injections, I would have likely believed that I was getting my disc injected.
After my conversation with Dr. Picard, I should note that the stem cell page on the website was quickly disabled. However, as of this morning, I am again able to find the page.
What Does Michigan Integrative Health Inject?
The clinic uses umbilical cord products. Do the umbilical cord products available to the clinic have mesenchymal stem cells? No, see the research performed by CSU below:
In this test of 5 common umbilical cord products, purple means stem cells and white is no stem cells, The purple you see on the right is the stem cell content of middle-aged and elderly bone marrow (which is commonly used to inject discs). On the left are 5 commonly used umbilical cord products which show zero stem cell content. Others have confirmed these same findings in birth tissue products (5-7).
Is There ANY Clinical Research Showing that Umbilical Cord Products Injected into Muscles Could Help DDD?
No, at the time of this writing, there is not a single study that has shown that injecting someone’s muscles with umbilical cord products will help degenerative disc disease. You can find studies that look at how mesenchymal stem cells injected into discs might help (3,4,8), but you now know that’s NOT what Michigan Integrative Health or many chiro clinics offer. In fact, it’s clear that this clinic (and many others) doesn’t offer real stem cell therapy for degenerative disc disease.
My Questions for Michigan Integrative Health
I sent the clinic several questions as Dr. Picard seemed very surprised when I told him about the research showing that umbilical cord products did not have live and functional stem cells. I was also surprised that Dr. Picard seemed to have very little independent knowledge of what tests would be required to show that the products his clinic was injecting actually had live and functional stem cells. In fact, he seemed to place the responsibility onto the tissue vendors who sold him the umbilical cord product, telling me that he would get the information I needed from them. At the time of this writing, I have not gotten a response. I will update the blog if the clinic does respond.
Three Questions You Can Ask to Identify Real Stem Cell Therapy for Degenerative Disc Disease
Here are some quick questions to ask these clinics:
- Who injects the cells into the disc? They need to say that this is being performed by a specialist physician who is boarded in pain management. A nurse practitioner or physician’s assistant (NP or PA) are not qualified to perform the actual disc injection procedure.
- What type of guidance is used? The only correct answer is C-arm fluoroscopy. These procedures CAN NOT be performed blind (no guidance) or using ultrasound
- What is injected? The only correct answer right now is stem cells derived from the patient’s own bone marrow. Umbilical cord or amniotic tissue contains NO live and functional stem cells.
The upshot? So it turns out that this chiro clinic is using a nurse to inject umbilical cord tissue that contains no living mesenchymal stem cells into spinal muscles. There is no disc injection nor stem cells involved. So buyer beware, as this is a common practice in many of the chiropractic clinics offering stem cells.
(1) Honorio T. Benzon, Srinivasa N. Raja, Spencer S. Liu, Scott M. Fishman, Steven P. Cohen,
Essentials of Pain Medicine (Fourth Edition), Elsevier, 2018, ISBN 9780323401968, https://doi.org/10.1016/B978-0-323-40196-8.12001-7.
(2) Zeckser J, Wolff M, Tucker J, Goodwin J. Multipotent Mesenchymal Stem Cell Treatment for Discogenic Low Back Pain and Disc Degeneration. Stem Cells Int. 2016;2016:3908389. doi:10.1155/2016/3908389
(3) Elabd C, Centeno CJ, Schultz JR, Lutz G, Ichim T, Silva FJ. Intra-discal injection of autologous, hypoxic cultured bone marrow-derived mesenchymal stem cells in five patients with chronic lower back pain: a long-term safety and feasibility study. J Transl Med. 2016;14(1):253. Published 2016 Sep 1. doi: 10.1186/s12967-016-1015-5
(4) Centeno C, Markle J, Dodson E, et al. Treatment of lumbar degenerative disc disease-associated radicular pain with culture-expanded autologous mesenchymal stem cells: a pilot study on safety and efficacy. J Transl Med. 2017;15(1):197. Published 2017 Sep 22. doi: 10.1186/s12967-017-1300-y
(5) Berger D, Lyons N, Steinmetz, N. In Vitro Evaluation of Injectable, Placental Tissue-Derived Products for Interventional Orthopedics. Interventional Orthopedics Foundation Annual Meeting. Denver, 2015. https://interventionalorthopedics.org/wp-content/uploads/2017/08/AmnioProducts-Poster.pdf
(6) Becktell L, Matuska A, Hon S, Delco M, Cole B, Fortier L. Proteomic analysis and cell viability of nine amnion-derived biologics. Orthopedic Research Society Annual Meeting, New Orleans, 2018. https://app.box.com/s/vcx7uw17gupg9ki06i57lno1tbjmzwaf
(7) Panero, A, Hirahara, A., Andersen, W, Rothenberg J, Fierro, F. Are Amniotic Fluid Products Stem Cell Therapies? A Study of Amniotic Fluid Preparations for Mesenchymal Stem Cells With Bone Marrow Comparison. The American Journal of Sports Medicine, 2019 47(5), 1230–1235. https://doi.org/10.1177/0363546519829034
(8) Pettine KA, Suzuki RK, Sand TT, Murphy MB. Autologous bone marrow concentrate intradiscal injection for the treatment of degenerative disc disease with three-year follow-up. Int Orthop. 2017 Oct;41(10):2097-2103. doi: 10.1007/s00264-017-3560-9.