Treating C0-C1 Facet Joint Pain with Stem Cells
Can advanced regenerative medicine techniques like a stem cell injection offer an alternative to facet joint ablation (radiofrequency treatment-the current standard for chronic neck facet joint pain)?
MC is a 30 year old woman involved in a work related incident about 5 years ago where very heavy boxes fell on her head. She sustained a brain injury and had severe pain in the upper neck as well as headaches. She tried and failed various forms of physical therapy and medications and had seen multiple specialists including neurologists to no avail.
When she was first evaluated by us in 2008, she was miserable with severe headaches four times a week and was severely limited in her activity. Prior to first seeing us, she was worked up for upper cervical facet pain by a competent interventional pain physician and ultimately ended up with a cervical facet joint rhizotomy (neurotomy). This is a procedure where nerves that signals pain from the joint are burnt out (ablated) with a needle where the tip heats up. The concept is that by “cutting the wires” carrying the pain signals, the patient won’t feel the pain from the permanently injured joint. Regrettably, this relief lasted only a few weeks, not the 1-2 years of relief that most patients can achieve with this procedure.
We felt her pain was much higher up in the neck and sent her for special imaging of the ligaments that hold the head on (alar and transverse ligaments). This MRI did demonstrate stretch injuries to these ligaments. We then tried facet joint injections at C0-C1 and C1-C2. These are neck joints that live just under the skull and are difficult to inject with x-ray guidance. In fact, only a handful of practitioners have the skills needed to inject these areas. She attained better relief with these injections, but the pain would always return at full force after 1-2 months. With nothing left to offer MC other than perhaps an implantable occipital stimulator (which we like to avoid due to the complications seen with implantable devices) or a very risky upper cervical fusion, she was entered into a Regenexx-C procedure study. She was injected 6 months ago and reports on follow-up this week that she is 75% improved and now able to return to skiing, riding horses, and other activities. We are glad to see MC making a recovery as without stem cell therapy we wouldn’t have been able to help her.
This case is another good example of the Regenexx difference. First, since this was a new technique for us, this patient was part of an IRB approved study and the patient continues to be tracked as part of a non-profit, third party treatment registry. Second, in order to know where to place stem cells in this difficult patient, you need a diagnosis based on a specific numbing injection (diagnostic block). There are 14 joints in the neck and for this patient, only two of those neck joints were causing most of her pain. Injecting stem cells into the wrong joint wouldn’t help the patient. Injecting stem cells IV or blindly into the neck tissues would never allow the stem cells to get to the right joint. In this patient, the “right joint” happened to be one that only a handful of physicians are trained to access using an injection guided by x-ray. In her case, Centeno-Schultz staff physicians are trained to access this complex joint. Then one had to decide which cells to use. The patient was entered into a study for Regenexx-C, but clearly some cells would work better than others in a joint. For example, fat derived cells would under perform to help repair a joint, while bone marrow derived cells would perform better. Candidate procedures to treat the joint would be the Regenexx-C, Regenexx-SD, and Regenexx-SCP procedures. While the Regenexx-SCP procedure uses cells that are blood derived and taken from an IV, the CD66e cells preserved in that mix have been shown to differentiate into orthopedic tissues.
Last, rather than mixing up cells in a beside centrifuge or using a kit to process cells at the bedside or in a patient room, these stem cells were processed in an advanced cell biology facility that’s part of our medical practice. This type of flexibility and leading edge investment in our patients allows us to lead rather than follow and as a result create new solutions for unique patients .