Interventional spine procedures have revolutionized the treatment of back pain, offering targeted therapies that address the root cause of the pain. One of the most promising approaches involves the use of regenerative medicine, which harnesses the body’s own healing mechanisms to repair and restore damaged tissues.

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Most lower back pain is mechanical in nature. It has been stated that over 90% of lower back pain is mechanical and therefore does not require surgical intervention.  In conventional medicine, mechanical back pain is said to arise intrinsically from the spine, intervertebral discs, or surrounding soft tissues. It’s often brought on when the spine moves, and muscle imbalances and wear and tear on joints over time may contribute to this mechanical pain.  However, if most back pain is mechanical in nature, how does it begin and why do we see a progression of degenerative structures of the spine once the process begins?  It all comes back to the supporting structural tissue medicine has abandoned - LIGAMENTS.

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The Underlying Cause: Ligament Instability

Ligament instability of the spine is often the underlying cause of the degeneration seen on radiological investigations. This instability results in abnormal biomechanical forces on the spine, loading up discs and facet joints. As a result, muscles weaken as they attempt to compensate for the ligament insufficiency.

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Ligaments play a crucial role in joint health and biomechanics. They are fibrous tissues that connect bones to each other, providing stability to the joint. But ligaments are more than just passive connectors; they also have a rich supply of sensory nerves that make them a key player in proprioception, the body’s sense of joint position.

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When a ligament is injured, such as in the case of a tear, it can lead to notable effects on the somatosensory and motor areas of the cortex. These neurological adaptations appear to be associated with clinical deficits that may contribute to poor long-term outcomes. The injury can lead to changes within the brain and central nervous system, which may underlie functional deficits. This includes somatosensory dysfunction, changes in motor system excitability, and plasticity of neural networks.

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The sensory nerves in the ligaments act as a feedback mechanism to the central nervous system, providing information about the health and biomechanical state of a joint region. This feedback is crucial for maintaining proper joint function and preventing injury. When this feedback system is disrupted, it can lead to joint instability and pain.

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Treating the Patient, Not the Scan

In the realm of regenerative medicine, it’s crucial to remember the importance of treating the patient, not the scan. While imaging can provide valuable insights into the structural issues at play, it does not always correlate with the patient’s symptoms or their experience of pain. Therefore, a comprehensive clinical evaluation is essential to guide treatment decisions.

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The Functional Spine Unit

The Functional Spine Unit (FSU) is a key concept in understanding and treating spinal disorders. Each FSU consists of two adjacent vertebrae, the intervertebral disc, and the corresponding ligamentous and muscular structures. By treating the FSU as a whole, we can address the complex interplay of forces and structures that contribute to back pain.

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Regenerative Medicine: Platelet Rich Plasma and Bone Marrow Concentrate

Regenerative medicine techniques, such as the use of platelet-rich plasma (PRP) and bone marrow concentrate (BMC), offer promising options for treating the structures of the spine. PRP is a concentration of platelets, which release growth factors that promote tissue repair. BMC contains mesenchymal stem cells and other important anti-inflammatory proteins that can co-ordinate healing processes in the human body, aiding in the regeneration of damaged tissues.

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With regenerative medicine, we can target a variety of structures in the spine:

• Facet Joints: These are small joints at each segment of the spine that provide stability and guide motion.

• Ligaments: These are the fibrous tissues that connect bones to each other, providing stability to the spine.

• Muscles: These tissues support the spine and facilitate movement.

• Nerve Roots: These are the initial segments of the nerves leaving the spinal cord, which can be a source of pain if compressed or irritated.

• Sacroiliac Joint Region: This is the joint between the spine and the hip, which can be a common source of lower back pain.

• Intra-discal Injections: These are injections into the intervertebral disc itself, which can help to reduce inflammation and promote healing.

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Interventional regenerative spine procedures offer a targeted and effective approach to treating back pain. By addressing the root causes of pain and treating the FSU as a whole, we can help patients achieve lasting relief and improved quality of life.

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As we continue to learn more about the complex interplay between the spine, the nervous system, and the rest of the body, we can hope to develop more effective treatments for back pain and other spinal disorders.