Stem Cell Therapy for Spinal Stenosis

A Patient’s Story: Two Years of Lower Back Pain

• The patient reported pain that was most prominent when sitting or lying on his stomach. MRI of his lumbar spine demonstrated moderate L3-L4 central stenosis due to a broad based disc bulge and facet degenerative change with hypertrophy.
• The patient underwent an epidural injection, physical therapy, and massage therapy none of which provided consistent pain relief.
• His resting pain was 3/10, active pain was 6/10, and functionality score was 17/40 at baseline.
• When I examined his lower back, the patient was diagnosed with a lumbosacral sprain.
• The patient underwent four bone marrow concentrate stem cell treatments within  146-day period.
• He experienced a minor improvement after the first treatment, reporting only dull aches with less frequency and stretching his lower back reduced the pain.
• After the third treatment, he reported improved ability to perform daily activities with less pain.
• At the short-term follow-up after the fourth treatment he experienced the most symptomatic relief, reporting a 75% total overall improvement.
• Another follow-up was administered approximately a year and half post-treatment, and his overall improvement increased to 90%. Additionally, his resting pain was 0/10, his active pain was 2/10, and his functionality score increased to 34/40.

These are two documented cases we published in the medical literature. Not every case will have this level of success.

What is Spinal Stenosis?

If you’ve been told you have spinal stenosis, it simply means the spaces within your spinal canal have started to narrow. Think of your spinal cord as a major highway for nerve signals traveling from your brain to the rest of your body. The bones of your spine, the vertebrae, form a protective tunnel around this highway. When that tunnel gets smaller, it can create a traffic jam, putting pressure on the spinal cord and the nerves branching out from it. This pressure is what leads to the frustrating and often debilitating symptoms associated with the condition, like persistent pain, numbness, or weakness.

It’s important to remember that a diagnosis of spinal stenosis on an MRI doesn’t always tell the whole story. As the case studies above illustrate, the pain you feel might actually be coming from surrounding soft tissues, like ligaments and tendons, that have become weak or injured. This is a critical distinction because it changes the entire approach to treatment. Instead of focusing only on the narrowed space, we can look at healing the damaged tissues that are actually generating the pain signals. This perspective opens the door to treatments that support your body’s natural healing process, rather than just managing symptoms or resorting to invasive procedures.

Defining the Condition

At its core, spinal stenosis is a structural issue—a narrowing of the bony canal that houses your nerves. This condition doesn’t happen overnight; it typically develops gradually over many years. The main problem arises when this narrowing starts to squeeze, or “impinge,” on the nerves. This compression can disrupt nerve function, leading to pain not just in your back or neck, but also along the path of the affected nerve. For example, pressure on a nerve in your lower back can cause shooting pains down your leg, a condition often referred to as sciatica. Understanding that the root of the problem is nerve compression helps clarify why the symptoms can be so varied and widespread.

Lumbar vs. Cervical Stenosis

Spinal stenosis can occur anywhere along the spine, but it’s most frequently found in two areas: the lower back and the neck. When it’s in the lower back, it’s called lumbar stenosis. This type often affects the nerves that go to your legs and feet, causing pain, tingling, or weakness in those areas. You might find that walking or standing for long periods makes it worse. When the narrowing happens in the neck, it’s known as cervical stenosis. This can impact the nerves leading to your arms and hands, resulting in similar symptoms but in the upper body. In some cases, it can also affect the legs, as the spinal cord itself can be compressed.

Common Causes and Symptoms

The most common cause of spinal stenosis is the natural aging process. Over time, the wear and tear of daily life can lead to changes in the spine. This includes osteoarthritis, where the cartilage that cushions your joints breaks down, leading to bone spurs that can grow into the spinal canal. Another frequent cause is a herniated or bulging disc, where the soft cushions between your vertebrae push out of place and into the nerve space. The symptoms that result from this narrowing can vary widely, but they often include back or neck pain, numbness or weakness in your arms or legs, and trouble with balance or walking. For many, the pain gets worse when standing or walking and feels better when leaning forward or sitting, as this temporarily opens up the spinal canal.

Why Doctors Are Rethinking Spinal Stenosis Surgery

Many of the patients we see are looking for a an alternative to spinal surgery. For many of these people, they have been told that surgery is the only option because an MRI showed stenosis. For some people surgery is the only answer, as in neurological defect. However, if the patient’s pain is in the lower back, we can have a realistic expectation that our treatments can help.

Why Are So Many Spinal Stenosis Surgeries Unsuccessful?

Despite the fact that many studies insist that surgical treatment is the best option for lumbar spinal stenosis, a startling study was published in the medical journal Spine. (2) In this study, American, Canadian and Italian researchers published their evidence:

“We have very little confidence to conclude whether surgical treatment or a conservative approach is better for lumbar spinal stenosis, and we can provide no new recommendations to guide clinical practice. . . However, it should be noted that the rate of side effects ranged from 10% to 24% in surgical cases, and no side effects were reported for any conservative treatment.” 

In the above research it should be pointed out the comparison between lumbar surgery and conservative treatments did not include stem cell therapy. They included the traditional conservative treatments including physical therapy, cortisone injections, pain medications and others listed below.

In 2019, researchers announced the formation of a new study (3) that would test whether conservative care treatment would offer better outcomes than lumbar stenosis surgery. Why? “Symptomatic lumbar spinal stenosis is the most common indication for spinal surgery. However, more than one-third of the patients undergoing surgery for lumbar stenosis report dissatisfaction with the results.”

Can Your MRI Results Be Misleading?

One of the reasons surgery may be no better than conservative care is that the surgery tried to fix a problem that was not there: Pain.

In the medical journal Osteoarthritis and Cartilage,(4) doctors reported that many asymptomatic individuals, those with no pain or other challenges, have radiographic lumbar spinal stenosis. In other words they only have lumbar spinal stenosis on the MRI.

The doctors noted:

• We found that 77.9% of participants had more than moderate central stenosis and 30.4% had severe central stenosis. Only 17.5% of the participants with severe central stenosis were symptomatic.
• They also concluded: Although radiographic lumbar spinal stenosis is common. Symptomatic lumbar spinal stenosis were relatively uncommon in these patients.

Exploring Alternatives to Spinal Stenosis Surgery

A diagnosis of spinal stenosis can be frightening because of the implications that a surgery may be needed to avoid paralysis. It is important to note that in instances where stenosis is so severe that the patient has lost circulation to the legs or bladder control – a surgical consult should be made immediately.

In the December 2017 edition of the medical journal Spine, (5) doctors from the University of Pittsburgh and University Toronto reported these observations in patients seeking non-surgical treatments for lumbar spinal stenosis.

• Three themes related to medical treatment and symptom management arose from analyses –
  • (1) an emotional response (depression, anxiety) to lumbar spinal stenosis;
  • (2) a desire for education about lumbar spinal stenosis and motivation to pursue education from any available source; and –
  • (3) a desire for individualized care based on self-management techniques and lifestyle changes.
  • Emotional responses were more evident in individuals receiving medical care, while the other two themes were consistent across all 3 treatment groups.

Individuals with lumbar spinal stenosis may believe misinformation and information from non-medical sources, especially when medical providers do not spend sufficient time explaining the disease process and the reasoning behind treatment strategies. Receiving individualized care focused on self-management led to fewer negative emotions toward care and the disease process. Clinicians should be prepared to address all three of these aspects when providing care to individuals with lumbar spinal stenosis.

Back pain can certainly cause anxiety, depression, and catastrophizing thoughts. The people in this study wanted education and involvement in their choice of treatment. I hope I can provide some for you here in this article.

Conservative Non-Surgical Treatments

When you’re first diagnosed with spinal stenosis, the typical path involves a range of conservative, non-surgical treatments. These are the foundational steps most doctors recommend to manage symptoms and improve function before even considering more invasive procedures. The goal here is to reduce pain and increase mobility through methods that support your body without the risks and recovery time associated with surgery. These approaches often include a combination of medications, injections, physical therapy, and bracing, each playing a specific role in your overall care plan.

Medications and Injections

Your doctor might first suggest over-the-counter pain relievers or prescribe medications like NSAIDs or muscle relaxants to manage your symptoms. If the pain persists, epidural steroid injections are another common option. While these can provide temporary relief, it’s important to weigh their effectiveness against the bigger picture. It’s a perspective supported by a significant Cochrane Library review, where researchers admitted they had “very little confidence to conclude whether surgical treatment or a conservative approach is better for lumbar spinal stenosis.” The review also noted that while surgical cases had side effect rates from 10% to 24%, “no side effects were reported for any conservative treatment,” underscoring why exploring these options first is a sound strategy.

Physical Therapy and Bracing

Physical therapy is a cornerstone of conservative care, focusing on specific exercises to strengthen the muscles supporting your spine, improve flexibility, and correct posture. This can help take pressure off the spinal nerves and reduce pain over time. A back brace may also be recommended for short-term use to provide stability and limit painful movements. Exploring these options is critical, especially when you consider that surgery isn’t a guaranteed fix. As researchers launching a study funded by the National Institutes of Health pointed out, while spinal stenosis is the top reason for spinal surgery, “more than one-third of the patients undergoing surgery for lumbar stenosis report dissatisfaction with the results.”

What Happens During Spinal Stenosis Surgery?

In the recommended surgical procedures for spinal stenosis, two choices are the most favored.

• A Decompression procedure where the surgeon will shave and cut away the bone narrowing the spinal canals.
• The second, a fusion procedure to limit the movement between two vertebrae and hopefully stop the compression of nerves.

A paper published in October 2017 gives a good outline where conservative medicine is in the treatment of Lumbar stenosis. It is from doctors at the University of South Carolina

• Current literature supporting the inclusion of physical therapy and gabapentin/pregabalin (nerve pain medications) within initial treatments have been positive.
• A recent randomized, double-blinded clinical trial of adding calcitonin (prevents bone breakdown) to epidural steroid injections have shown improvement in pain and function up to 1 year.
• The minimally invasive lumbar decompression (mild) procedure is showing ongoing beneficial results in pain and function.
• Spinal cord stimulation (SCS) may have a role for select patients with lumbar spinal stenosis.
• Finally, the benefits of surgical treatment versus nonsurgical treatment is ultimately inconclusive because of the nature of data collection, inconsistencies.(6)

This is indeed a fair assessment of SOME of the treatment options available to patients.However, not all doctors agree. At New York University in June 2017 research, doctors wrote:

The highest levels of evidence do not support minimally invasive surgery over open surgery for cervical or lumbar disc herniation. However, minimally invasive surgery fusion demonstrates advantages along with higher revision and hospital readmission rates. These results should optimize informed decision-making regarding minimally invasive surgery versus open spine surgery, particularly in the current advertising climate greatly favoring minimally invasive surgery.(7)

Minimally Invasive vs. Open Spine Surgery: Does It Matter?

Researchers at the University of Sydney say that the evidence for recommending lumbar spinal surgery as the best option to patients is lacking and it is possible that a sham or placebo surgery can deliver the same results.(8)

In the research I cited at the top of this article, doctors at the Italian Scientific Spine Institute in Milan wrote:  We cannot conclude on the basis of this review whether surgical or nonsurgical treatment is better for individuals with lumbar spinal stenosis. We can however report on the high rate of effects reported in three of five surgical groups and that no side effects were reported for any of the conservative treatment options.(9)

“Considering the majority of these procedures are unnecessarily being performed for degenerative disc disease alone, spine surgeons should be increasingly asked why they are offering these operations to their patients”

A team of Japanese researchers found that  patients with lumbar spinal stenosis who do not improve after nonsurgical treatments are typically treated surgically using decompressive surgery and spinal fusion surgery. Unfortunately the researchers could not determine if the surgery had any benefit either.(10) Maybe the patient’s problem was not the stenosis?

Now let’s go to another paper that has more of an opinion: From Dr. Nancy Epstein of Winthrop University Hospital:

• “The incidence of nerve root injuries following any of the multiple minimally invasive surgical techniques resulted in more nerve root injuries when compared with open conventional lumbar surgical techniques. Considering the majority of these procedures are unnecessarily being performed for degenerative disc disease alone, spine surgeons should be increasingly asked why they are offering these operations to their patients?”(11)

Surgeons at Leiden University Medical Centre in the Netherlands speculate that doctors go into a diagnosis of  lumbar spinal stenosis with the thought that there is osteoarthritis – a bony overgrowth on the spinal nerves. Once determined, the symptoms of patients can be categorized into two groups; regional (low back pain, stiffness, and so on) or radicular (spinal stenosis mainly presenting as neurogenic claudication – nerve inflammation).

In the patients who primarily complain of radiculopathy (radiating leg pain) with an stable spine, a decompression surgery may be recommended to remove bone from around the nerve root to give the nerve root more space. The surgeons warn of the fear that surgery to a stable spine will make it unstable.(12)

A fusion procedure to limit the movement between two vertebrae and hopefully stop the compression of nerves is another option. As mentioned by independent research above – surgery for spinal stenosis should only be considered after conservative therapies have been exhausted. Surgical treatment of lumbar spinal disorders, including fusion, is associated with a substantial risk of intraoperative and perioperative complications,as pointed out in the research by surgeons from Catholic University in Rome.(13)

Why Do I Still Have Pain After a “Successful” Surgery?

In the medical journal Public Library of Science one, a November 2019 study (14) from a combined group of 22 medical researchers look at post-surgical patients with degenerative lumbar spinal stenosis from 13 surgical spine centers. The patients were deemed to be good surgical candidates. Following pain and disability testing in the follow up periods post surgery, the researchers concluded that.

“Although most patients experienced important reductions in pain and disability, 29% to 42% of patients were classified as members of an outcome trajectory subgroup that experienced little to no benefit from surgery. These findings may inform appropriate expectation setting for patients and clinicians and highlight the need for better methods of treatment selection for patients with degenerative lumbar spinal stenosis.”

Treatment with Bone marrow derived stem cells and PRP

Bone growth occurs in the spine because the bone is trying to stabilize the spine from excessive movement or laxity. Fusion surgery is recommended as a means to accelerate that type of stabilization. Regenerative medicine including PRP and Stem Cell Therapy (watch the video) works in a completely different way. They stabilize the spine by strengthening the often forgotten and underappreciated spinal ligaments and tendons. These techniques help stabilize the spine, which is imperative as unstable joints can lead to – or further exacerbate – the arthritis that causes spinal stenosis.

In the medical journal Insights into imaging, researchers wrote of the four factors associated with the degenerative changes of the spine that cause spinal canal stenosis:

• disc herniation.
• hypertrophic facet joint osteoarthritis, (an overgrowth of bone)
• ligamentum flavum hypertrophy (inflammation of the spine’s supporting ligaments – the ligamentum flavum).
• and spondylolisthesis (stress fractures causing the vertebrae to slip out of place)

The same research suggests that these conditions can prevent the formation of new tissue (collagen) which can initiate repair.(15)

Collagen is of course the elastic material of skin and ligaments. Here the association between collagen interruption and spinal stenosis can be made to show spinal instability can be THE problem of symptomatic stenosis.

A study on what damaged spinal ligaments can do 

A  study in the Asian Spine Journal investigated the relationship between ligamentum flavum thickening and lumbar segmental instability, disc degeneration, and facet joint osteoarthritis. Ligament thickening is the result of chronic inflammation. Chronic ligament inflammation is the result of a ligament injury that is not healing.

What these researchers found was a significant correlation between ligamentum flavum thickness, spinal instability and disc degeneration. More so, the worse the degenerative disc disease, the worse the ligamentum flavum thickness.(16)

PRP and stem cells address the problem of ligament damage and inflammation. Addressing these problems address the problems of spinal instability. Addressing the problems of spinal instability can address the problems of spinal and cervical stenosis.

References
1 Darrow M, Shaw BS. Treatment of Lower Back Pain with Bone Marrow Concentrate. Biomed J Sci&Tech Res 7(2)-2018. BJSTR. MS.ID.001461. DOI: 10.26717/ BJSTR.2018.07.001461.
2 Pazarlis K, Punga A, Schizas N, Sandén B, Michaëlsson K, Försth P. Study protocol for a randomised controlled trial with clinical, neurophysiological, laboratory and radiological outcome for surgical versus non-surgical treatment for lumbar spinal stenosis: the Uppsala Spinal Stenosis Trial (UppSten). BMJ Open. 2019 Aug 20;9(8):e030578. doi: 10.1136/bmjopen-2019-030578. PMID: 31434781; PMCID: PMC6707759.
3 Zaina F, Tomkins‐Lane C, Carragee E, Negrini S. Surgical versus non‐surgical treatment for lumbar spinal stenosis. The Cochrane Library. 2016 Jul 1.
4 Lynch AD, Bove AM, Ammendolia C, Schneider M. Individuals with lumbar spinal stenosis seek education and care focused on self-management–results of focus groups among participants enrolled in a randomized controlled trial. The Spine Journal. 2017 Dec 12
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11 Epstein NE. More nerve root injuries occur with minimally invasive lumbar surgery: Let’s tell someone. Surg Neurol Int. 2016 Jan 25;7(Suppl 3):S96-S101. doi: 10.4103/2152-7806.174896. eCollection 2016.
12 Overdevest GM, Moojen WA, Arts MP, Vleggeert-Lankamp CL, Jacobs WC, Peul WC. Management of lumbar spinal stenosis: a survey among Dutch spine surgeons. Acta Neurochir (Wien). 2014 Aug 7. [Epub ahead of print]
13 Proietti L, Scaramuzzo L, Schiro’ GR, Sessa S, Logroscino CA. Complications in lumbar spine surgery: A retrospective analysis. Indian J Orthop. 2013 Jul;47(4):340-5. doi: 10.4103/0019-5413.114909.
14 Hebert JJ, Abraham E, Wedderkopp N, Bigney E, Richardson E, Darling M, Hall H, Fisher CG, Rampersaud YR, Thomas KC, Jacobs B. Patients undergoing surgery for lumbar spinal stenosis experience unique courses of pain and disability: A group-based trajectory analysis. PloS one. 2019;14(11):e0224200-.
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16 Yoshiiwa T, Miyazaki M, Notani N, Ishihara T, Kawano M, Tsumura H. Analysis of the Relationship between Ligamentum Flavum Thickening and Lumbar Segmental Instability, Disc Degeneration, and Facet Joint Osteoarthritis in Lumbar Spinal Stenosis. Asian Spine Journal. 2016;10(6):1132-1140. doi:10.4184/asj.2016.10.6.1132. 2373