April 18, 2009
A low back disc is made up of an inner part which is filled with a gel like substance (NP- nucleus pulposis) and an outer part which acts as a layered, tough fibrous container for the gel (AF- annulus fibrosis). The problem is that as we age, the gel dries out because the cells that make the gel start to die off. As this happens, the disc becomes a poor schock absorber. In addition, the whole structure can weaken and the gel can bulge out through the tough outer covering. The problems start when the bulge starts to press on a nerve causing sciatica. Surgery can weaken the disc by cutting out parts of the outer covering, which leaves less of the tough fibrous annulus to contain the dried out gel. Is there a better way? Yes, we’ve demonstrated that your own stem cells injected into this disc using a special procedure (Regenexx procedure) can in fact make the disc bulge smaller (by repairing the tears in the annulus). In addition, we’ve also seen evidence on MRI of the inner part of the disc regaining the ability to hold onto water and becoming a shock absorber again. The FDA has taken a funny position on your own stem cells. In the interim, you can use your own cells to fix your back!
April 9, 2009
What constitutes a new drug? We all have stem cells that live inside of us, are they tissue or drugs? It makes a big difference in the availability of stem cell treatments for millions of Americans. If the adult stem cells that live inside us can be minimally culture expanded like fertility clinics do everyday, then safe stem cell therapy can be quickly available to the masses. The FDA’s position has been that this type of minimal culture work means a new drug is being created, yet does that make sense? While there are many things that can be done to the patent’s own stem cells to make them drugs (insert new genes, grow them for extended periods, make significant changes to their make-up), growing them for short periods like the Regenexx procedure doesn’t qualify. For more on the issue, see the SafeStemCells patient movement of the American Stem Cell Therapy Association. These outfits have stated that adult stem cells aren’t drugs, they are tissue that should be available to physicians as tools to safely treat patients under strict guidelines run by physician groups.
December 17, 2008
Can knee surgery lead to lumbar spine pain? As a spine doctor, I think the question should be the other way around: Can low back pain lead to knee pain? Why? Everyday in the clinic we see patients with knee pain who really have a back problem and nothing wrong with their knee. Many of these patients get surgery due to an incidental finding on an MRI showing a meniscus tear. After the surgery fails to help, they notice their back hurts. Since it was their back that was causing the knee pain in the first place, it’s not a stretch to see why their back eventually hurts. How is this possible? Meniscus tears in the knee are normal findings in 60% of the patients. Yes, that’s right, 6 in 10 patients with meniscus tears in their knees have something seen on MRI that is normal and not causing their pain.
How do I really know this to be true? Besides seeing patients everyday like this, I am a fellow low back-knee patient. Ten years ago at a medical conference I did allot of sitting and all of sudden my knee hurt. I limped around the office for months, got an MRI which was thankfully normal (or I would have had an unnecessary surgery) and was miserable. It wasn’t until a bright medical provider treated my back that my knee pain went away. When he first suggested my back was leading to my knee pain, I thought he was crazy because my back didn’t hurt.
How does this happen? The upper lumbar nerves (L2, L3, L4) refer their pain to the front of the knee and thigh muscle. In addition, SI joint pain can also refer in that same area. My own experience with chronic intermittent L5 and S1 pain tells me that S1 refers pain to the back and outside of the knee that can at times travel down to the outside of the ankle and that L5 goes to the outside (sometimes inside) knee that can also at times go down to the big toe.
Look at the low back nerve map below (dermatomes). Follow the L2, L3, L4 nerves down to the thigh area. Follow L5 to the outer knee.
Can knee surgery lead to lumbar spine pain
So when you have pain in your knee and your back hurts, don’t believe the MRI until your back is ruled out as a cause. And yes, changes in walking style and bio mechanics can lead to low back pain when you have a bum knee, but it’s usually the other way around. I’ve posted two videos below that might be of interest:
December 13, 2008
Low right side back pain can have multiple causes. The SI joint can cause pain around the PSIS area (the dimple on each side in the low back). This is the joint between the tailbone and pelvis. Most of these patients can point to the pain in this area (Fortin finger test). SI joint pain can be treated by steroid injection, but if this provides only short-term relief, other options include prolotherapy, radiofrequency ablation, and adult stem cell injections. Low right side back pain can also be caused by pain coming from a torn or damaged disc. Irritated upper lumbar spinal nerves or lower throacic spinal nerves can also cause pain in this area. Other causes include myofascial trigger points in muscles such as the quadratus lumborum and lower lumbar paraspinal muscles. In addition, the facet joints can also cause pain. These are small finger sized joints in the low back that help control motion. Steroid shots under x-ray guidance can help this pain, as can radiofrequency ablation, or stem cell injections into the joints. Finally, internal organ problems such as kidney issues, abdominal pain, or even aneurysms of the aorta.
December 13, 2008
Low back pain has many causes. When low back pain radiates to quadriceps, possibilities include:
- SI Joint Syndrome: The SI joints are the articulations between the tailbone and pelvis. They can be injured by trauma or can get arthritis just like any joint. SI joint pain can also cause significant low back pain near the tailbone or lateral hip. For more information on SI Joint Syndrome.
- L2, L3, or L4 nerve root compression in the low back. These nerves can refer tingling, pain, numbness, or other symptoms to the quadriceps area (front of thigh). It is also possible for other lumbar nerve roots to be perceived in this area. These picnhed nerves can also cause low back pain. For more information on things that can compress nerves such as bulging discs.
- Femoral cutaneous neuropathy: The femoral nerve has a skin branch that provides sensation to this area and can be irritated at the ASIS (anterior superior iliac spine).
- Quadriceps, adductor, or psoas myofascial trigger points: The muscles can develop knots and these areas of trigger points can refer to the quadriceps area. In addition, trigger points in the low back (upper lumbar spine and quadratus lumborum) can refer to the quadriceps area.
- Hip Osteoarthritis: Hip pain usually refers to the groin or upper quadriceps area. For more information on hip osteoathritis.
- Iliopsoas Bursitis: There is a lubricating sac near that makes the psoas muscle pass over the front of the hip more easily. The pain from this bura can radiate to the quadriceps. More information in iliopsoas bursitis.
December 13, 2008
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