The Top 5 Ways to Avoid Spine Stem Cell Treatment Scams
You’re a patient with back or neck pain and you want to try stem cells. What do you need to know to avoid getting scammed? Here are the top 5 things to understand and know so that you don’t get scammed by a bad provider.
Before we dig in today, I can go over some common spine terms and help you understand how the spine comes together. Watch my video below if you need a quick review:Request a Regenexx Appointment
Why Write this Blog?
I often write about what I experience. This week, yet another patient got scammed by a clinic that offered to treat his complex neck issue. This wasn’t a bad clinic, but one that had no expertise in the spine. Not wanting to lose the patient, they brought in a “spine doctor” to perform what the patient thought was stem cell injections into his facet joints, but turned out not to be. Hence, this patient spent big bucks on low-level spine care when he could have spent the same on a procedure that actually had a higher chance of helping. All because he didn’t do his homework.
How Big a Problem Is This?
As the first physician on earth to inject stem cells into the low back discs, I can say that most places you can go right now that are offering stem cell therapy for the back or neck are not able to deliver advanced care. In fact, from what I see, that’s as high as nine in ten places offering to treat these areas! So how can you avoid getting scammed? Just understand these 5 scams:
The Intrathecal/Epidural Scam
Why Would You Need it Injected? If you have sciatica or spinal nerve pain, this is when this injection is usually used. Common issues on MRI would include a pinched nerve due to disc bulge or herniation or a bone spur causing spinal stenosis.
What Is It? These are injections that place stem cells inside the spinal canal either above the covering of the spinal cord and nerve roots (epidural) or inside that covering (intrathecal). Performing these procedures correctly takes years of proper training and x-ray guidance with a radiographic contrast to confirm placement. The real injection looks like this:
Here you see C-arm fluoroscopy, proper surgical prep, and a procedure room designed for x-rays.
This is what a fake injection looks like:
Notice that there is no fluoroscopy, no imaging guidance, no sterile field, and the “doctor” (in this case a naturopath) just sticks the needle in the middle of the spine and dangerously hopes for the best.
While you can plainly see the difference, here are some questions to ask the clinic:
- Who will perform my injection? I need to know what degree they have and where they performed their residency and fellowship training.
- THE RIGHT ANSWER: Dr. X is an M.D. or D.O. physician who performed his residency training in physical medicine or anesthesiology at Y University and his fellowship in interventional pain or interventional orthobiologics at Z university or clinic.
- THE WRONG ANSER: You will be injected by a nurse practitioner, chiropractor, naturopath, or acupuncturist.
- Do you have C-arm fluoroscopy on-site and will the doctor be using that to perform my procedure and be using contrast to confirm the placement.
- THE RIGHT ANSWER: Yes, we have C-arm fluoroscopy in a dedicated procedure room and the doctor will be using it to perform your injection with radiographic contrast.
- THE WRONG ANSWER: No, the provider is quite experienced and doesn’t need to using imaging guidance.
The Fake Facet Injection
This one is a really big problem that just happened to new a patient of mine just this week.
Why Would You Need it Injected? If you have back or neck pain that gets worse when you extend, the facet joints might be causing that pain. The pain can also refer to places like the upper back from the neck, or even down the leg a bit if the painful facet joint is in the low back. These joints can become injured with trauma or get arthritis with wear and tear just like any joint.
What is it? There are injections INSIDE the facet joints, which are finger-sized joints in your spine that occur two at each level. Again, it takes years to learn how to correctly perform these procedures using x-ray guidance and radiographic contrast. What you’ll find out there are three levels from totally fake, to mostly fake, to real:
- Totally Fake: This is a blind injection where no imaging guidance is used and the doctor just sticks the needle in the vicinity of where he or she believes the facet joint lives. Because this is a deep structure, what’s the likelihood that the doctor is inside the joint? Almost nil.
- Mostly Fake: The doctor uses x-ray guidance, but just places the needle in the vicinity of the joint and doesn’t use radiographic contrast to ensure placement of the stem cells inside the damaged joint. This is often described as “periarticular” or “facet capsule” injections.
- Real: The doctor uses x-ray guidance (fluoroscopy) to place the needle inside the joint and then injects a tiny amount of radiographic contrast to ensure that the stem cells will go INSIDE the damaged joint.
Here are some questions to ask the clinic:
- Does the doctor use x-ray guidance to place the stem cells into my facet joint and confirm that placement with radiographic contrast?
- THE RIGHT ANSWER: Yes, the doctor uses fluoroscopy guidance to place the cells inside the facet joint and uses radiographic contrast to ensure that’s where they really go.
- THE WRONG ANSER: No, the provider is quite experienced and doesn’t need to using imaging guidance.
Muscle Trigger Points are Not Sophisticated Spine Care
These are clinics that don’t have any ability to inject deep spinal structures, so they just inject muscle trigger points. However, what’s crazy here is that these clinics will often have statements about disc disease or facet problems or pinched nerves on their websites, but when push comes to shove, all they can really do is to inject stem cells more superficially into the muscles.
Why Would You Need it Injected? While muscle and tendon injections in the spine may be a great adjunct to injecting other painful areas like around nerves, into the discs, or into the facet joints, this is rarely a standalone therapy in the spine.
What is it? A muscle trigger point is a hyperactive part of the muscle that’s painful and shut down. These spots can usually be treated with soft-tissue work or dry needling, but in rare cases could need orthobiologics like PRP or stem cells.
Here are questions to ask:
- Does the doctor perform spinal injections using x-ray guidance into specific structures like facet joints, epidural, or discs and confirm those injections with radiographic contrast?
- THE RIGHT ANSWER: Yes, the doctor uses fluoroscopy guidance to place the cells inside those structures and uses radiographic contrast to ensure that’s where they really go.
- THE WRONG ANSER: No, the provider is quite experienced and doesn’t need to use imaging guidance. We find that injecting into the muscles helps most people with back or neck pain.
The Disc Bait and Switch
What’s really bizarre is that most stem cell clinic websites that talk about disc problems like bulges, herniations, or degenerative disc disease have no ability to inject the disc. They just don’t have providers who have this unique skill set and equipment needed to accomplish this procedure.
Why Would You Need it Injected? The discs are the shock absorbers between the vertebrae. They can become painful and torn, which leads to pain with short periods of sitting. They can also collapse and when that happens this is called degenerative disc disease.
What is it? An intradiscal injection is when a doctor uses a fluoroscope to use x-rays to place a needle inside the disc. Contrast is injected to make sure that the doctor is injecting inside the disc.
Most clinics that say that they can do this, just inject spine muscles instead. See what the two looks like below:
Here are questions to ask:
- Does the doctor perform an injection of the disc using x-ray guidance with radiographic contrast?
- THE RIGHT ANSWER: Yes, the doctor uses fluoroscopy guidance to place the cells INSIDE the disc and uses radiographic contrast to confirm that placement.
- THE WRONG ANSER: No, the provider is quite experienced and doesn’t need to use imaging guidance.
THERE IS NO WAY TO INJECT THE DISC WITHOUT X-RAY GUIDANCE. So if a clinic tells you they can do that, please run.
The Pain Generator Short Cut
So let’s say you find a clinic that can do all of these injections using x-ray guidance. You have one more step to make sure you’re in the right place. The problem is that most pain management clinics use what’s called a “pain generator approach”. This means that they try to find a single area that hurts the most. These clinics then apply that same approach to using stem cells in the spine. Why is this a problem?
Stem cells in the spine allow us as doctors to think differently. Meaning, if a facet joint hurts, why? The facet damage was likely caused by excessive movement of that spinal level due to degenerative disc disease and lax ligaments. Hence, while placing stem cells in the facet joints will help, you should also take the opportunity to inject ligaments to tighten those down and reduce the instability. In fact, this new approach to painful back and necks often means injecting many different parts and pieces at once.
So how can you tell if you have a clinic that knows this approach? Ask this question:
- Does the doctor plan on just injecting the part that he thinks hurts or to inject my whole spine and areas that may be causing the problem?
- THE RIGHT ANSWER: Yes, the doctor uses a whole spine approach and usually injects the areas that hurt along with ligaments, nerves, muscles, and other things to help stabilize the degenerative spine.
- THE WRONG ANSER: No, the doctor usually just injects the part that hurts the most.
Since the medical providers who are offering this care either should know the difference or do know the difference, IMHO offering spine care when you have no ability to use x-ray guidance to inject inside the epidural space, facet joints or disc is fraudulent. At the very least, as a physician or medical provider, you have an obligation to let the patient know that what you’re doing is basic and if that doesn’t work they need to find someone who knows more about how to inject the spine. However, it’s shocking how infrequently that happens.
The upshot? As you can see, you have to stay diligent to find the right clinics that can maximize your chances of recovery from low back or neck pain. There are clinics out there that aren’t on our network that can do this the right way. They may not have access to all of the advanced orthobiologics we use, but they know what they’re doing in the spine. Most clinics do not. Or you could just click here to find a Regenexx clinic near you that already does all of this stuff the right way.