Alternative Treatments For Common Conditions
By Dr. Brian Shiple
The new field of Regenerative Medicine seeks to find safer and more effective treatments for common conditions with less risk of complication and easier recovery. In this article we will be highlighting two types of treatments frequently used in our practice for conditions that do not have many known successful treatment options aside from surgery: platelet releasate injections for inflamed nerves and joints and intra-osseous stem cells (stem cells injected into the bone) for avascular necrosis (dying bone).
The most common treatments used for inflamed nerves and joints in the United States are steroid injections. Epidural steroids are used over 9 million times a year in our country for back pain caused by nerves that are inflamed by herniated discs. Steroids not only do not fix the cause of the problem, they come with many adverse side effects, and their efficacy has been called into question by a recent large meta-analysis study. The results showed that at best a standard epidural steroid treatment gives modest short-term improvement for spinal nerve pain. A viable alternative treatment is a platelet releasate injection instead. We have discussed platelet rich plasma injection treatments throughout our series of articles for use in treating muscle, tendon, ligament, and joint injuries, rejuvenating the skin of the face, restoring sexual function in men and women, and treating urinary incontinence. A platelet releasate (PR) injection is similar to a platelet rich plasma (PRP) injection, but involves activating the platelets and spinning the sample an additional time so that the growth factors are suspended in the plasma. This makes it a very potent anti-inflammatory treatment that helps to de-inflame the nerves that have been irritated by a chronically injured or herniated disc and can actually help heal them offering long-term, rather than temporary pain relief without the risks and side effects of steroids. Fluoroscopic x-ray or high-resolution ultrasound guidance is always used for a platelet releasate epidural injection in order to ensure precise, pinpoint placement of the needle in the correct spot to allow for a safe and effective treatment. Platelet releasate injections may also be used in arthritic joints, such as facets in the spine and the sacroiliac (S/I) joints in the lower back, as well as in the treatment of inflamed, compressed nerves such as in the wrist for carpal tunnel syndrome. While platelet releasates may take longer to take effect than a steroid, treating the cause of the problem at hand with a safe, natural, and effective anti-inflammatory has helped to keep our patients off of addictive pain medications and avoid dangerous surgeries.
Some patients with such severe inflammation in their joints, whether due to trauma, arthritis, or long-term steroid or alcohol use or abuse, develop a condition called avascular necrosis (AVN). This occurs when the blood supply to an area of bone is interrupted and that bone begins to necrose or die. This can cause small fractures in the bone and lead to eventual structural collapse. While AVN can occur in any joint in the body, we will highlight avascular necrosis of the hip, specifically. This is a fairly common condition that affects a decent amount of our patients due to loss of the delicate blood supply to the femoral head in this ball and socket joint. Once lost, the bone in the femur head starts to die and this shows up on MRI as an increased image intensity making it quite obvious for diagnostic purposes. AVN can be extremely painful, especially once the blood supply is completely shut off. It is usually painful not only while trying to bear weight, but also while at rest. The standard care in orthopedic surgery for treatment of avascular necrosis is called core decompression. This involves drilling a large tunnel from the femur to the femoral head to decompress the congested, dying bone in the hopes that once the hole is drilled, the bone will fill back in with new blood vessels and bone re-establishing a healthy blood supply, saving the bone from death, future collapse, and the need for joint replacement. If caught early, this treatment is only effective about 60-70% of the time. A safer, less invasive, more effective treatment option that we have offered in our practice since 2010 includes injecting adult, concentrated bone marrow stem cells into the dying bone. Bone marrow stem cells have a very potent revascularization effect and can establish new blood flow in the dying bone, allowing it to recover. A French orthopedic surgeon, Dr. Phillip Hernigou, has performed over 4,000 bone marrow concentrate injections into the head of the femur with a much higher degree of success than core decompression. After long term follow up of these thousands of cases, Hernigou’s work has shown that he is able to help these patients avoid total joint replacement in 80-90% of cases. While withdrawing bone marrow from the iliac crest to obtain stem cells and inject them back into your area of dying bone may sound painful, rest assured that extensive nerve blocks and local anesthetic are used to ensure patients are as comfortable as possible during both aspects of the treatment process. Over 90% of patients rate the pain of the treatment at a low level, say they would do it again, and would recommend it to friends and family. Fluoroscopic x-ray guidance is used to inject the stem cells into the precise area of avascular necrosis. This treatment has been used in bones of our patient’s hips, shoulders, knees, hands, and feet. It has also been used in our practice to treat delayed healing and non-union fractures with high success rates, without surgery.
Credentials:
Dr. Brian Shiple is a highly accomplished sports medicine board certified physician. Dr. Shiple is one of the leading interventional regenerative medicine physicians on the east coast and uses platelet rich plasma and adult stem cells for the healing of musculoskeletal conditions. He has been practicing age management wellness and aesthetic medicine for over 8 years. He has been in practice for 23 years and is a highly sought after speaker, educator, and author.
