Marc Darrow MD, JD. Thank you for reading my article. You can ask me your questions about your back pain using the contact form below.
I am an avid golfer. People who are my patients understand my great passion for this game. Many of these people are my patients because of a back pain problem that is impacting their ability to play golf. In April of this year, Tiger Woods, arguably the greatest golfer of all time, won the Pro Golfers Tour (PGA) Master tournament after years of physical decline and back surgeries. Woods’ victory was considered remarkable and miraculous because of the numerous failed back back surgeries he had.For Woods, it was the fourth surgery that was the “charm.”
Some of our patients have asked us about the spinal fusion surgery (the 4th surgery) that Tiger Woods had 2 years ago in 2017, this was the “successful” surgery. They want to know if this surgery may be right for them? We tell our patients the reality is very likely not. How come? I will let the spinal surgeons and back pain researchers discuss this with you now in this article.
“An outcome like his from fusion surgery is so rare it is like winning the lottery”
On May 15, 2019, New York Times health writer Gina Kolata published a story entitled: “How Tiger Woods Won the Back Surgery Lottery.” The reason for this title? It is explained by Dr. Sohail K. Mirza, a spine surgeon at Dartmouth who said: “An outcome like his from fusion surgery is so rare it is like winning the lottery.”
Why is successful fusion surgery so rare?
This was explained by Dr. Charles A. Reitman, co-director of the Spine Center at the Medical University of South Carolina in the NY Times article: “People with a broken spine, for example, or scoliosis, which is severe spinal curvature, or spondylolisthesis, in which vertebrae slip out of place, tend to have terrific results, he said. But those are a tiny minority of fusion patients. The vast majority of fusion procedures are performed on patients with one or more degenerated disks, disks that are worn out, dehydrated, stiff and friable. And when those disks move, patients’ backs can ache.”
From the same article: Tony Delitto, of the University of Pittsburgh’s School of Health and Rehabilitation Sciences, says he tries to warn patients seeking fusion surgery for a deteriorated disk not to expect too much.“I would be very, very hesitant, and most surgeons would be very, very hesitant to tell patients that after fusion they would be pain-free,” he said.
Fusion surgery is very rarely successful – it is infact a bad gamble
A study that appeared in the medical journal Radiologia (Radiology) examined the traditional recommendations of sending a patient to get an MRI and then offering a fusion surgery based on what the MRI indicated. The researchers had concerns about the enthusiasm some surgeons had for surgery that was likely inappropriate.
This is from the study:
- Most imaging findings (Scans and MRIs), find degenerative changes that reflect anatomic peculiarities or the normal aging process and turn out to be clinically irrelevant.
- Imaging tests have proven useful only when systemic disease is suspected or when surgery is indicated for persistent spinal cord or nerve root compression.
- Many treatments (surgeries) have proven inefficacious, and some have proven counterproductive, but they continue to be prescribed because patients want them and there are financial incentives for doing them.”(1)
The keywords of the research are “ineffective,” and “counterproductive,” for the patient.
“If your goal is cure, that isn’t what (Spinal Fusion) is going to offer”
Back to the NY Times article:
Dr. Steven Atlas, an associate professor of medicine at Harvard, said he tells patients that it is one thing for an athlete like Woods to have that operation — it may be risky but he also might get a few more years out of his playing career, which could be worth millions of dollars. But he cautions typical middle-aged patients. “Once they have that fusion, it can’t be undone,” Dr. Atlas said. “And it is likely that they will have future surgery down the road,” as a consequence of the instability fusion causes.
“If your goal is cure, that isn’t what this is going to offer,” he said.
I am going to continue on with the study from the Department of Orthopaedics, Icahn School of Medicine at Mount Sinai, New York, New York.. This study furthers the evidence that spinal fusion is at best a risky surgery. Here is the learning points of this research.
- “Not only is Intervertebral disc degeneration seen on imaging studies not indicative of low back pain, but patients with discogenic back pain are also poorly indicated for surgery.”
- “Given the difficulties in determining who will benefit from surgery, the American College of Physicians recently updated their LBP treatment guidelines, recommending noninvasive, nonpharmacologic treatments as the first line of therapy.” (2)
In a study published in the Journal of Neurosurgery, Spine that examined patients with back pain, investigators found that patients in fact did expect to get an MRI when they have back pain and that the MRI will reveal exactly what the cause of their pain is. Not only that but:
- more than 50% of the patients would have a spinal surgery if their doctor told them they had an abnormal spinal MRI, even if they had no pain or restricted movement.
- A large proportion of patients (33%) believed that back surgery was more effective than physical therapy in the treatment of back pain without leg pain.
- Nearly one-fifth of the survey group (17%) also believed that back injections were riskier than back surgery.
- CONCLUSION: “Patients overemphasize the value of radiological studies and have mixed perceptions of the relative risk and effectiveness of surgical intervention compared with more conservative management. These misconceptions have the potential to alter patient expectations and decrease satisfaction, which could negatively impact patient outcomes and subjective valuations of physician performance.”(3)
The evidence has been presented by leading surgeons and medical universities. The odds of having a successful fusion surgery, can be like winning the lottery, you can hope, but the odds will be against you.
Can we help you with your back pain without surgery? We would need you to come into our office so we can assess your situation and work to reduce your pain.
Are you a candidate for non-surgical treatment of your back pain? Ask Dr. Darrow
A leading provider of stem cell therapy, platelet rich plasma and prolotherapy
11645 WILSHIRE BOULEVARD SUITE 120, LOS ANGELES, CA 90025
PHONE: (800) 300-9300
1. Kovacs FM, Arana E. Degenerative disease of the lumbar spine. Radiologia. 2016 Apr;58 Suppl 1:26-34. doi: 10.1016/j.rx.2015.12.004. Epub 2016 Feb 10.
2 Mosley GE, Evashwick‐Rogler TW, Lai A, Iatridis JC. Looking beyond the intervertebral disc: the need for behavioral assays in models of discogenic pain. Annals of the New York Academy of Sciences. 2017 Aug 10.
3. Franz EW, Bentley JN, Yee PP, Chang KW, Kendall-Thomas J, Park P, Yang LJ. Patient misconceptions concerning lumbar spondylosis diagnosis and treatment. J Neurosurg Spine. 2015 May;22(5):496-502. doi: 10.3171/2014.10.SPINE14537. Epub 2015 Feb 27.
There is controversy in the medical community about umbilical cord blood stem cells. Some insist that the injectable solution contains abundant live umbilical cord blood stem cells. Some suggest that the stem cells are not alive. I have seen the flow cytometry showing live stem cells. The research shows that these stem cells release cytokines and growth factors that awaken native stem cells. I have tried this treatment on myself for both shoulders and knees. After great success, I started using this treatment on patients. I still use PRP and bone marrow depending on the patient’s pathology and requirements. To date the results are excellent for all of these treatments. We are in the process of doing a study on cord blood stem cells (we have done others on bone marrow and PRP) to see which treatments are the most successful. We are awaiting more long term results.
In our practice we often see patients who are in severe back pain. These people have an MRI, X-ray and/or scan that shows an inaccurate picture of what is causing their pain. What do we mean by inaccurate picture?
Marc Darrow MD, JD. Thank you for reading my article. You can ask me your questions using the contact form below.
We have published a new study on PRP for chronic low back pain. The study appears in the journal Cogent Medicine.(1)
This research gives an insight into what level of treatment success we can have with certain back pain conditions and how many treatments the patient should expect towards achieving their treatment goals.
Let’s get to our study:
In our research, Treatment of Chronic Low Back Pain with Platelet-Rich Plasma Injections, we wrote:
- Platelet-Rich Plasma (PRP) is a non-invasive modality that has been used to treat musculoskeletal conditions for the past two decades. Based on our research, there were no publications that studied the effect of PRP on unresolved lower back pain. The aim of this study was to report the clinical outcomes of patients who received PRP injections to treat unresolved lower back pain.
- 67 patients underwent a series one, two, or three PRP injections into the ligaments, muscle, and fascia surrounding the lumbar spine.
- Patients who received two treatments received injections a mean 24 days apart and patients who received three treatments received injections a mean 20.5 days apart.
- Baseline and post-treatment outcomes of resting pain, active pain, lower functionality scale, and overall improvement percentage were compared to baseline and between groups.
- Patients who received one PRP injection reported 36.33% overall improvement and experienced significant improvements in active pain relief. These same patients experienced improvements in resting pain and functionality score, yet these results were not statistically significant.
- Patients who received a series of two and three treatments experienced significant decreases in resting pain and active pain and reported 46.17% and 54.91% total overall improvement respectively. In addition, they were able to perform daily activities with less difficulty than prior to treatment.
The learning points of our study:
- Our results demonstrate that PRP injections may be a viable conservative approach to treat lower back pain.
- Quickly return to everyday activities:
- Our study demonstrated that one, two or three PRP treatments were effective in significantly reducing active pain in the lower back. Additionally, functionality scores were significantly increased showing that patients were able to quickly return to everyday activities.
- An immediate clinical benefit:
- Patients experienced an improvement in resting pain and functionality score after the one treatment, however, statistical significance was demonstrated only after the second and third treatments. Yet, self-reported mean total improvement was 36.33%, 46.17%, and 54.91% at the first, second and third treatments, respectively, suggesting an immediate clinical benefit.
Our explanation of how PRP works
- PRP is fast, non-invasive procedure that has been studied as an alternative treatment for low back pain and musculoskeletal injuries in the recent decade.
- The treatment invokes immunomodulatory effects (it activates the immune and repair response and as well as angiogenic (formation of new blood vessels) properties that facilitate healing.
- The exact mechanism of PRP is not known, but current research points to cytokines (small cells that set up communications between cells to coordinate the healing response), growth factors and other proteins as the main medium through which PRP works.
To learn more about PRP visit our page PLATELET RICH PLASMA PRP
Demonstration of PRP treatment
There is no sound on this video. The video demonstrates PRP injection into the lower back. The procedure is well tolerated, simple and in the hands of an experienced physician is a multiple injection treatment given in rapid succession. In our many years of experience, this type of PRP treatment offers the patient reliable and effective results such as those demonstrated in our study above.
There is no sound on this video. The simplicity of the injection treatment is demonstrated. By injecting PRP into the muscles, ligaments, and fascia surrounding the lumbar spine, we can improve the stability of your spine. This has been shown not only in the research discussed in this article, but in additional published studies. PRP injections can relieve lower back pain and may prevent future spinal disc problems.
Supportive research on PRP for low back pain
New research in the Journal of spine surgery (2) featured these findings which may help confirm that PRP injections are a viable option to low back pain.
- Clinical studies presented in this research clearly demonstrate the growing interest in offering PRP injections for treating back pain
- These same studies used PRP injections as a therapy for discogenic low back pain and reported good results overall.
- A major and notable advantage of the therapy is the safety of the autologous PRP itself, which does not cause any major complications.
- Because autologous PRP is obtained from the patient’s own blood, PRP therapy carries low risks of disease infection and allergic reaction.
Clinical benefits reported:
- Research on PRP therapy has demonstrated remarkable improvements in pain intensity according to a variety of pain scores.
- The clinically-beneficial effects have enabled patients to return to normal physical activity.
Clinical concerns reported:
- PRP therapy will be more efficient if applied before disc degeneration reaches an advanced stage.
Conclusion of this research:
“(the authors of this study) described clinical evidence from the literature and presented an update on the use of PRP therapy for the treatment of discogenic low back pain. It is evident from our review that PRP is a safe, effective and feasible treatment modality and is evolving as a powerful therapy for the treatment of discogenic back pain. Considering the remarkable progress made already, and the other potential aspects which remain for further investigation, PRP therapy undoubtedly offers new and exciting prospects for the treatment of degenerative disc disease and other musculoskeletal disorders.”(2)
PRP injections not into the disc but into the supporting spinal ligament structures
In our own recently published and companion research: Treatment of Lower Back Pain with Bone Marrow Concentrate (3) we discuss the injections of bone marrow cells not directly into the discs, but into the supportive spinal ligaments. This is what we documented:
- The patients in the present study were injected with Bone Marrow Concentrate into the muscles, fascia, and ligaments surrounding the lumbar spine.
- It has been well documented in literature that stem cells and platelets in the concentrate enhance tendon and ligament healing.
- In patients who were diagnosed with ligament and fascial (connective tissue) sprains, we hypothesize that we can reduce patients’ low back pain by strengthening these anatomical areas.
Treating these structures with Bone Marrow Concentrate we were able to report:
- at one-year follow-up, 100% of (4) patients in this study experienced a decrease in resting and active pain in addition to performing daily activities with less difficulty.
- All four patients experienced sustained or increased improvement at annual follow-up compared to short-term follow-up.
- On average, patients reported an 80% decrease in resting pain, a 78% decrease in active pain, and a 41% increase in functionality score.
Are these treatments right for you? We have more than 20 years experience in helping patients with low back pain and we have seen many different types of low back pain. Knowing if these treatments are right for you begins with a conversation:
Are you a candidate for treatment? Ask Dr. Darrow
A leading provider of stem cell therapy, platelet rich plasma and prolotherapy
11645 WILSHIRE BOULEVARD SUITE 120, LOS ANGELES, CA 90025
PHONE: (800) 300-9300
(2019) Treatment of unresolved lower back pain with platelet-rich plasma injections, Cogent Medicine, DOI: 10.1080/2331205X.2019.1581449
2 Marc Darrow, Brent Shaw BS. Treatment of Lower Back Pain with Bone Marrow Concentrate. Biomed J Sci&Tech Res 7(2)-018. BJSTR. MS.ID.001461. DOI: 10.26717/ BJSTR.2018.07.001461.
3 Mohammed S, Yu J. Platelet-rich plasma injections: an emerging therapy for chronic discogenic low back pain. J Spine Surg. 2018;4(1):115-122. 1263