Want to See an Advanced Image-Guided Injection? Step into Our Procedure Suite with Dr. Pitts

By Chris Centeno, MD /

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Time and time again, on this blog or in my videos, I’ve discussed our advanced image-guided injections.  But unless you’ve been one of our patients or you work in one of our network clinics, you may still have no idea what this really means. To really understand why Regenexx is very different, we want you to step into one of our procedure suites and take a look at one of our treatments. You are about to see Dr. Pitts perform an advanced image-guided injection neck procedure that your orthopedic surgeon can’t do, the guy down the street who does a little bit of ultrasound can’t do, and over 99% of pain-medicine doctors can’t do.

The video above is brief, but you’ll get to stand alongside Dr. Pitts as he performs an injection in the cervical spine (the neck). You’ll also get a peek at some of the sophisticated equipment we use, so let’s take a look at what Interventional Orthopedics looks like in a neck procedure.

Advanced Image-Guided Injection Terminology Used in the Video

Below, I’ve defined some of the medical terms that you will be introduced to in the video:

Neck Facet JointsThe neck facet joints are 14 small (about finger-joint size) joints in the cervical spine, two at each of the seven cervical levels. Dr. Pitts will be performing bilateral injections at the C0–C1, C1–C2, and C7–T1 levels on the patient in the video.

Innervate—When Dr. Pitts talks about nerves that innervate a joint, this simply means the nerves that supply that joint. When there are easily accessible nerves that innervate a joint, such as you will see Dr. Pitts discussing as he performs this procedure, most doctors in traditional settings will ignore treating these joints as they cannot access the nerves to burn them (the traditional standard method of treating the pain). Is burning perfectly fine neck nerves a good idea? No!

Injectate—Injectate is simply the material that is being injected. You will see a beautiful real-time fluoroscopy image as Dr. Pitts injects contrast dye as an additional safety measure to make sure the injectate is indeed filling the joint and not missing the joint or getting into a blood vessel.

Contrast Dye—While the contrast dye allows the doctor to see on fluoroscopy where the injectate is going (see “injectate” above), it can also serve a diagnostic purpose. If the some of the contrast leaks out, this tells the doctor the joint is incompetent, a sign that the capsule and ligaments around it are unstable. If this leakage is present, as part of the Regenexx methodology, we will treat the ligaments as well.

X-ray Guidance—With X-ray guidance, we take a spot-live, or real-time, image as the procedure is being performed to determine appropriate placement of the needle. This is called fluoroscopy.

Equipment Used in the Video

In addition to the terminology, watch for a couple of key pieces of equipment we frequently use for our injection procedures. Fluoroscopy is the real-time X-ray–imaging machine Dr. Pitts is using to assure the injection is properly placed. In the background, you will see our full surgical monitor, which measures our patients’ vital signs during their procedure and assures us they are handling the procedure well. Other standard equipment we use or have available in our procedure-suite setup includes ultrasound as well as oxygen, a crash cart, and an automated defibrillator in the rare case of an emergency. You can read more about our clinic setup on yesterday’s “cell therapy deception” post.

Compare and Contrast

Believe it or not, most of the physicians out there offering stem cell injections in the neck don’t use any of this equipment to make sure cells are getting into the right spot. They instead perform blind injections and have no idea where the cells are going. For those that do use guidance, those physicians rarely have the skill level to inject the upper neck joints as you see Dr. Pitts doing here. These joints, when injured, can cause headaches and as such are targets for stem cells or PRP. Again, note that the art of injecting things into neck joints is fast being lost because of the use of radiofrequency ablation (RFA), where the doctor can bill an insurance carrier for burning (damaging) a nerve to snip the “wires” for the pain signal. However, if you can help a joint by ramping up repair, why would you want to burn its nerves away and possibly create new problems? Your guess is as good as mine.

Also note that while Dr. Pitts is injecting the joints, he’s also planning on injecting the ligaments. Why? When the neck is injured with forces strong enough to injure the joints, the ligaments that hold the neck bones together can also get injured. These ligaments can also get loose as we age. This laxity can cause even more wear and tear on the joints as well as pain. When all we had was steroids to inject, treating ligaments made little sense. But now that we’re entering into a new world of regenerative therapies, injecting the damaged ligaments to help them heal just makes more sense. However, doctors who have interventional spine training to inject neck joints have never been trained how to inject the ligaments.

The upshot? Regenexx is very different. I hope this video gives you a good understanding of what our advanced image-guided procedures look like.

Category: Neck/Cervical

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4 thoughts on “Want to See an Advanced Image-Guided Injection? Step into Our Procedure Suite with Dr. Pitts

  1. Tamara

    Why would you need to monitor the patient’s vitals and have oxygen and a crash cart at the ready? What could possibly happen as a result of the injections that would make these things necessary?

    1. Chris Centeno Post author

      Any spinal injection needs this type of facility. The inadvertent injection of anesthetic into the area around the nerves (intradural) can be an issue. While using imaging makes this unlikely and complications are a fraction of what they are with surgery, it’s always better to be safe.

  2. Rosalind Bodington

    I have been reading your emails for almost a year now and am fascinated by what you all do.
    With acute on chronic Cxsp and Txsp pain , due to muscle dural bridge, facet jtC2/3, Gd1 degenerative spondylolysthesis T2/3, all resulting from prolonged NWB crutch use after knee surgery and to cap it all chiropractic manipulation which my Physio colleagues has made the upper Cxsp unstable, the brain stem is inflamed apparently. … I need to come to you for treatment I think?
    Please advise where i might be referred and the cost? I am currently under specialists at John Hopkins Aramco Hospital in Saudi Arabia and London and Gloucester in U.K. I am an English MSK Physio, happy to volunteer for research anything to get out of pain.
    Are you the only team in the world performing this treatment?

    1. Chris Centeno Post author

      Rosalind, which injection? Our Colorado office is the only one performing direct injection of the alar, transverse, and accessory ligaments. There are a few centers injecting PRP and stem cells into the facets and neck ligaments. Upper cervical C0-C2 narrows that list as only about 100 US physicians have significant experience injecting these levels and only a handful of those would inject with anything other than steroids.

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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