The field of Regenerative Medicine (Orthobiologics) is one of the most exciting advances in medicine in a very long time. Regenerative Medicine includes the use of orthobiologics, products that are naturally occurring in the body, which are used to heal injuries. The novel idea behind these treatments is to heal damage, rather than cutting it out or prescribing medication to cover the pain. The products that make up this field include platelet-rich plasma (PRP), platelet-rich fibrin (PRF), amniocytes and stem cells. Dr. Martin has been performing regenerative medicine treatments on patients since 2009 during her fellowship in Chicago. She considers it very important to sit with her patients and discuss whether or not they would benefit from one of these treatments, as well as discussing realistic expectations from these procedures. Dr. Martin has been a leader in the state of Colorado in the field of Regenerative Medicine and is currently performing extensive research in an effort to further this field of medicine. She works very hard to educate patients and other medical providers about these alternative treatment options and has given numerous presentations all over the state.
Platelet-rich plasma (PRP) has been used for many years in medicine. Its use ranges from assistance in healing damaged tissue, such as cartilage, tendon and muscle, to aesthetic medicine, such as hair growth and skin appearance. In an effort to maintain the highest level of care for our patients, Dr. Martin is now offering platelet-rich fibrin (PRF) in lieu of PRP. PRF was discovered more recently and has been found to be a superior product to PRP. The process of obtaining PRF is very simple. A small amount of blood is taken from the patient and then placed in a special centrifuge. This centrifuge separates the layers of blood and allows the platelet-dense layer to be collected for use. This final product is then placed into a syringe and can be injected directly into an area of injury. Platelet-rich fibrin is made up of both a high concentration of platelets and growth factors (GF), as well as a lower concentration of stem cells, white blood cells and red blood cells. This high concentration of platelets and GF mimics the initial stages of inflammation that naturally occurs in the body around areas of damaged tissue, as the body prepares to heal the tissue. In creating these conditions around an injured area, a complex cascade of events is jump-started, which stimulates cells that can repair tissues and suppresses cells that cause further damage, thus enhancing repair and minimizing breakdown. This process can lead to accelerated tissue healing, a faster recovery and a reduction in recurrence.
There are some specific differences between PRP and PRF. PRF is processed in the centrifuge using a lower spin speed so that more stem cells can be maintained in the platelet product. PRF also has the advantage of using less heparin during the processing so that the final product is essentially more pure. The typical PRP product has anywhere from 2-5 times the platelet concentration that we typically have in our body. A PRF product has at least 10 times the platelet concentration we have in our body. Overall, PRF is the direction that platelet-derived regenerative medicine products will be moving in. We are very pleased to offer this product already.
A second product in the regenerative medicine family is amniocytes. This product is collected from the amnion of the placenta. This product is extremely rich in cytokines and growth factors, with fewer stem cells than products taken from the umbilical cord. Amniocytes can be used as a stand-alone treatment, or they can be coupled with PRF or a stem cell product for intense synergy. Amniocytes activate the body to begin a strong healing response in the area of tissue damage, and they also help to create a strong healing matrix that is unique specifically to this product. The matrix of the amniotic membrance tissue can provide the structural support needed to enhance tissue strength and healing.
Stem cells also fall under the umbrella of Regenerative Medicine. Stem cells are naturally occurring cells found within most tissues of the body. Higher concentrations of stem cells are seen in tissues such as adipose (fat) and bone marrow. Stem cells are currently collected from three locations, the adipose tissue (fatty tissue), bone marrow and placentas/umbilical cords. It is important to note that the placentas used in Regenerative Medicine are obtained directly following scheduled cesarean sections, and neither mother nor baby is harmed in the process. The umbilical cords used in regenerative medicine are obtained directly following scheduled cesarean sections and vaginal births, and neither mother nor baby is harmed in the process. Furthermore, placentas and umbilical cords cannot be obtained without permission; a mother chooses to give away her placenta/umbilical cord. After the mother delivers her baby, the placenta and umbilical cord are collected from the hospital and processed to separate the stem cells for use. The donor stem cell product that is used at SJS is a product taken from the Wharton’s Jelly within the umbilical cord, which is extremely rich in stem cells. This product has proven to provide a high concentration of stem cells. The final product is stored at approximately -196° and is not thawed until just prior to being used. Given the high concentration of stem cells within this product, a very small amount is typically required during treatment. For example, a knee joint injection will require only 1 mL of product, which has well over one million stem cells. Using donor stem cells is an excellent option for individuals who have chronic illnesses, such as autoimmune conditions, or who have undergone significant medical treatments, such as chemotherapy or radiation. Donor stem cells also give you a very straightforward treatment option that does not require a blood draw or a bone marrow aspiration procedure to be performed. Recent literature suggests that individuals who are over the age of 60 should consider using donor stem cells, as the concentration of stem cells in our body significantly decreases as we age.
Stem cells collected from the bone marrow are another excellent option for stem cell therapy. The bone marrow aspiration procedure that is used at SJS is also considered cutting-edge. Using a very specific aspiration needle that is withdrawn out of the bone slowly during the aspiration process, the stem cells that are collected from the bone marrow are concentrated immediately, which eliminates the need for the product to be processed, which could potentially damage a portion of the cells. The cell mixture is placed into the body through an injection and placed directly over the damaged tissue. Placing stem cells into a region creates a cascade of events that begins with a protein being released from the injected platelets. This protein allows the platelets to bind to stem cells, which creates a signal that causes the stem cells to do three separate things. First, the stem cells have the ability to self-replicate, meaning they create more stem cells. Second, the stem cells can differentiate, meaning they become tissue. For example, if the stem cells are placed near damaged cartilage, they can differentiate into cartilage and aid in healing areas of injury. Third, the implanted stem cells can signal for other stem cells in the area to migrate to the injury site. All of these processes create a high concentration of cells that can heal tissue quickly and effectively, allowing a patient to avoid more invasive and costly treatments. All bone marrow aspiration procedures performed by Dr. Martin are performed in a sterile setting at a surgical center under x-ray guidance.
Regenerative Medicine can be used for numerous types of injuries in the body. At Spine & Joint Solutions, the focus is on treating the musculoskeletal system. This includes all peripheral joints and soft tissue. In addition, in an effort to decrease degenerative disc disease and heal annular tears or disc herniations, either PRF or stem cells can be placed into the discs. When regenerative cells are placed in the facet joint, damage to the cartilage within the joint can be repaired and painful local inflammation decreased. This treatment has been especially helpful in those receiving radiofrequency ablation therapy for facet syndrome.
Another extremely important topic is that of visualization. Dr. Martin takes great pride in performing every regenerative medicine procedure under either ultrasound guidance or x-ray guidance. All joint and soft tissue injections are visualized where the site of the injection can be evaluated and the needle can be seen entering the region to be treated, which provides reassurance that the medication is going in the correct location. For spinal conditions, x-ray guidance is used to appropriately localize either the disc or facet joint to be treated and is also used to make sure the location of the needle is accurate and safe. Dr. Martin considers it absolutely essential to perform all procedures under guidance in an effort to provide as excellent of care as possible.
Ongoing research in the field of Regenerative Medicine is crucial. Spine & Joint Solutions is collecting data on every patient that undergoes either PRF or stem cell therapy in order to publish necessary literature to advance this technology.
In addition to the use of platelets, amniocytes, and stem cell therapy, we offer several supportive therapies to enhance your overall recovery and outcome. The key to optimal success with regenerative medicine therapy is synergy. More and more studies are showing that combining cellular therapy with specific types of additional therapies provides superior outcomes than using cellular therapy alone. Some of the additional therapies offered at Spine & Joint Solutions include peptide therapy, shock wave therapy, and LED light therapy.