Why Fixing My Back Can Help You Fix Yours

I’ve had chronic off-and-on back issues for many years. However, recently, I got a little crazy with lifting an impossibly heavy object and needed an updated treatment. However, I discovered my new diagnosis late. That error will hopefully help you fix your low back. Let me dig in.

My Bad Back History

When I was a resident physician at Baylor College of Medicine in the early 90s, I traveled from Grand Rounds back to the hospital where I was assigned. Someone cut me off because I was driving a hopped-up Jeep Wrangler with tires that were far too big, and in trying to avoid that car, I rolled the Jeep. I was also not wearing my seatbelt, so I felt like a rag doll in a washing machine as the Jeep rolled a few times. When it stopped, my back felt like it was broken, and indeed, x-rays in the ER showed that I had fractured three bones. I spent six weeks in a hard shell back brace called a TLSO, and ever since then, I’ve needed to manage my back. Through the years, I’ve had platelet-based injections around nerves, into arthritic facet joints, and into lax ligaments. My back had found its happy enough place until recently.

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A Shuffleboard

We bought our kids one of those long shuffleboard tables for Christmas. It sat around for a few months in the box because it was impossibly heavy. Then about a month ago, I finally got the gumption to transport it to our second home. Between getting this 300-pound box into the U-haul, back out again, and downstairs, I knew that this was very dicey on my back. Sure enough, my back has been talking to me ever since.

Planning My Treatment

I knew from my medical history that I had developed a degenerative spondylolisthesis at L5-S1. Hence, my goal was to get an updated set of ligament injections to help with the instability in addition to facet injections at that level because the extra motion can cause wear and tear arthritis in those joints. Hence, I underwent a blood draw to create a platelet lysate (growth factor) spiked prolotherapy solution for the ligaments and high-dose PRP for the facet joints.

It’s important to note that the second part of that procedure, an intra-articular facet injection takes sophisticated image guidance skills where the needle is placed inside the facet joint and confirmed with injected radiographic contrast. That’s quite different from the average clinic offering regenerative medicine low back injections that only injects the ligaments and muscle trigger points and cannot inject these facet joints.

Imaging Findings on Fluoroscopy Injection

While getting my back injected yesterday, we discovered why my back had some new pains after the 300-pound shuffleboard box. My L5-S1 spondylolisthesis (where L5 was shifted forward of the sacrum) was much better and not an issue, but the new problem was that now L4 had shifted forward of L5, meaning the shuffleboard box had caused a new spondylolisthesis. The problem was that all of the PRP had already been injected in the lower L5-S1 facets by the time the physician noticed the new problem on the fluoroscope.

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Learning Why the L4-L4 Facets Need to be Injected

If the ligaments were already being injected and loose ligaments were causing this instability at L4-L5, why would the facet joints need to be injected?

As you can see above on the left, the ligaments that prevent the forward motion of one vertebra on the other are in the posterior of the spine and orange. On the right, when the L4 moves forward of the L5, that puts extra stress on the L4-L5 facet, as shown by the yellow. Hence, if I now have spondylolisthesis at L4-L5, I need a facet PRP injection at that level to assist with the self-repair capabilities of that joint. I’ll get that done soon.

Why Tell You This Story about My Back?

The main reason to tell this tale is that my own back injections had two components that were critical for helping me recover from my battle with the 300-pound shuffleboard box:

  • Level 0 or 1 ligament injections, as shown above
  • Level 2 facet joint injections using fluoroscopy and contrast

Meaning that had I gone to a Mexican, Latin American, or US clinic offering prolotherapy, I would have only gotten the lower-level ligament injections, so only half a treatment. To get the other critical part, I would have needed to go to a clinic offering precise interventional spine procedures using X-ray guidance and contrast confirmation.

To learn more about this issue, see my Facebook Live below:

The upshot? I hope that by sharing my recent low back flare-up, you’ve learned a little something about why simple spine injections often don’t work. In this case, I needed facet joint injections, but I could have also needed the disc or epidural space injected as well. Hence, at a clinic offering low-level care, I would have gotten only half a regenerative medicine treatment.

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. View Profile

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NOTE: This blog post provides general information to help the reader better understand regenerative medicine, musculoskeletal health, and related subjects. All content provided in this blog, website, or any linked materials, including text, graphics, images, patient profiles, outcomes, and information, are not intended and should not be considered or used as a substitute for medical advice, diagnosis, or treatment. Please always consult with a professional and certified healthcare provider to discuss if a treatment is right for you.

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