At RestorePDX, one of the ways we try to help patients understand the structure and function of their spine is by comparing it to something most people see on an almost daily basis: a skyscraper. Like a tall building, a healthy spine is straight, structurally sound, and stable, with 24 bony vertebrae each serving as “floors” in your “Spinescraper”–which would actually rise to a grand total of 33 “floors” if you include the nine fused vertebrae of the sacrum and the coccyx. These “floors” are directly stacked one on top of the other and connect at three “joists” or points of contact: one, called an intervertebral disc, on the anterior side of the spine and two more, called facet joints, on either side of the posterior spine.
When stacked, these tripods enclose a central canal–the elevator shaft in our building analogy–that harbors the spinal cord and its branching nerve roots, which exit through “elevator doors” called foramen at each level on either side of the spine. All of this is held together by a dense, interconnected network of ligaments, tendons, and muscles–the nails, sheetrock, and steel beams of our building–to create the working, bending, nerve signal-communicating spine that we all know and love.
Whether through the natural process of aging or acute injury, the structural elements of your “Spinescraper” can unfortunately break down and lead to pain and injury. While the traditional standard of care calls on providers to progress through physical therapy, narcotic pain medication, steroid injections, and ultimately invasive single- or multi-level fusion surgery, at RestorePDX we believe there is a different way. By harnessing the innate ability of the body to heal itself, we believe the structured approach of regenerative medicine–what we call the Three-Legged Stool or Precision Diagnosis, Precision Biologics, and Precision Delivery–can reduce or eliminate back pain without the need for surgery. This is accomplished by taking your own cells from fat, bone marrow, or PRP and injecting the structural elements–the intervertebral discs, facet joints, foramina, canal, and ligamentous structures that hold it all together–that are wearing out and causing pain.
When done correctly, this structured approach creates an organic fusion/stabilization of sorts that helps hold the spine together and prevent the excess movement in the “floors” that causes pain. While this will not completely prevent all movement like a classic surgical fusion, the use of regenerative medicine in the spine has the potential to dramatically reduce or completely resolve back pain, as well as promote healing of the damaged tissues. However, while regenerative medicine holds great promise in the treatment of chronic and acute low back pain, it is not a one-size-fits-all treatment. It takes a trained, expert physician to properly diagnose the source of a patient’s pain and determine which orthobiologic treatments are right for their individual condition.
Some of the spine conditions we have seen respond favorably to regenerative medicine treatments include:
Degenerative Disc Disease
Degenerative disc disease describes a gradual or acute weakening of the intervertebral discs. This weakening can be driven by the natural process of aging or through an acute injury to the back or neck. A weakened intervertebral disc will lose many of the properties that allow it to function as a prime shock absorber, leaving the “floors” of your “Spinescraper” less stable and more likely to wobble. In turn, this instability leads to pain and further structural damage in the spine. A weakened disc can also bulge, herniate, or rupture, placing pressure on the spinal cord that causes radiculopathy and can ultimately lead to paralysis if left untreated.
Facet joints, the aforementioned posterior “joists” of the “Spinescraper,” are synovial joints protruding from the posterior side of each vertebra. Like many other joints of the body, the facet joints are lubricated with synovial fluid and cushioned by cartilage, both of which can weaken and degrade over time, leading to bone-on-bone contact in the joint. Facet arthritis can also be caused by a “wobble” in the floor above or below any given vertebrae, which leads to instability in the joint and greater pressure than usual on the points of contact in the joint. Over time, facet arthritis will lead to pain, stiffness, and inflammation in the spine, as well as nerve impingement that can cause radiculopathy.
Foraminal + Central Canal Stenosis
The foramina function as the elevator doors of the “Spinescraper,” serving as exit points, two per level, for the nerve roots that branch off the spinal cord and into the body proper. The nerve roots that feed through the foramen service the hands, feet, heart, lungs, and every other organ and limb essential to life. If these elevator doors get blocked, the nerve roots can get squeezed and placed under great pressure, leading to pain and radiculopathy. This clogging can be the result of bone spurs; inflammation and swelling; bulged, herniated, or ruptured discs; or other degenerative changes caused by instability in the “Spinescraper” superstructure.
Similar to foraminal stenosis, central stenosis describes an impingement on the spinal cord. However, in central stenosis the spinal canal, not the foramen, is the space that narrows, leading to pressure on the spinal cord itself and not just the nerve roots. One common manifestation of central stenosis is a condition called neurogenic claudication; it describes painful cramping of the legs and buttocks as a result of nerve impingement caused by a narrowing of the spinal canal. These symptoms are generally aggravated by standing or walking and relieved by sitting or bending forward at the waist. Fortunately, RestorePDX has found great success relieving the symptoms of neurogenic claudication using an outpatient procedure called the MILD (Minimally Invasive Lumbar Decompression) Procedure, which uses a tiny incision to remove excess bone and ligament tissue from the spine to open up space in the spinal canal and allow the nerve roots and spinal cord to once again pass freely through the canal.
Sciatica is a very common condition of the low back wherein some form of “Spinescraper” pathology pushes in on the sciatic nerve and causes pain, numbness, and tingling down the buttocks and into the leg. The responsible pathologies can include a degenerative disc pathology, narrowing of the foramina or spinal canal, or a bone spur pressing on the nerve.
If you are suffering from low back pain and think you might benefit from the regenerative medicine approach, contact RestorePDX today to take the first step on your road to recovery!