Following a weightlifting injury in July 2015, Tom, a 49 year-old gentleman, began to experience persistent low back pain with radiation into his buttock and occasionally into his calves.
Conservative Treatments Tried
After two weeks of rest, he underwent extensive conservative care including chiropractic manipulation, physical therapy and dry needling without significant improvement in his symptoms.
He had a lumbar MRI done in February 2016. His MRI was significant for degenerative disc disease at L3-S1 and facet arthropathy at L4-5. There was a small central disc herniation at L4-5 without significant stenosis. His L4-5 disc was moderately degenerative.
There was mild degenerative changes noted at L3-4 and L5-S1. There were annular tears at all three levels. He subsequently underwent diagnostic/ therapeutic injections in the winter of 2016. He had approximately 40% short term improvement following facet injections at L4-5.
He had little to no improvement following lumbar epidural steroid injections. His daily pain scores continued to range from 7/10 to 8/10.
The Stem Cell Procedure
The patient was seen in my office in August 2016. After examination and review of his clinical history and imaging, I recommended that he undergo regenerative injections with a combination of fat derived stem cells and bone marrow concentrate into the L3-S1 discs and L4-5 facets.
This stem cell procedure was carried out in October 2016. He was seen again in November 2016 for a follow-up injection with bone marrow concentrate. Both procedures went smoothly and aside from some post injection soreness, he had no complications.
Stem Cell Injection Follow-Up Exam Results
On follow-up examination in January 2017, Tom reported significant improvement in pain and mobility and his daily pain scores had fallen to 2/10-4/10. He also reported that the radiating pain into his posterior thighs and calves had completely resolved. He had returned to pilates and yoga which no longer flared up his back pain.
Short Term Results
At six months post-procedure, the patients pain scores had fallen further to 0/10-2/10 and he reported that he was back to working out in addition to pilates and yoga. He stated that his pain had continued to improve and he felt markedly better than pre-treatment.
Long Term Results
When we reached out to him one year following his procedure, he noted the pain that had originally brought him to see me remained significantly improved. He noted a new pain in his low back. On examination this appeared to be secondary to SI joint dysfunction. Diagnostic injections confirmed this diagnosis.
This patient demonstrates the finding of a new low back pain source following successful treatment of lumbar degenerative disc pain. There are often times when the return of symptoms in close proximity to an area treated in the past are not secondary to recurrence of the prior etiology. Tom asked if we would treat his SI joints in a similar manner to the procedure that had so effectively resolved his spine pain.
Stem Cell Therapy For SI Joint Dysfunction
In November 2017, the patient underwent a combined procedure with fat derived stem cell and bone marrow concentrate into his SI joints bilaterally. His procedure was carried out without complication and he experienced very little postoperative discomfort. His secondary injection into the SI joints was done in December 2017 with bone marrow concentrate.
Results From Second Round of Stem Cell Therapy
At his 3 month follow-up, Tom reported a 50% improvement in his SI joint pain which combined with the dramatic gains from his spinal procedures had the patient returning comfortably to a much more vigorous exercise schedule.
At his 6 month follow-up, the patient demonstrated significant benefit with 80% improvement in his symptoms.