Regenerative medicine has great potential. It empowers the body’s own healing mechanisms to cure injuries that would normally require surgery or other invasive measures.

In this episode of Back Talk Doc, Dr. Peter Bailey discusses his work in regenerative spinal care. 

Research on regenerative spinal care is steadily progressing, despite a lack of funding. Most companies fund research into drugs rather than regenerative medicine, so progress has taken time and dedication. In spinal care, regenerative treatments can improve patient pain. For this to be effective, the cause of the pain must be accurately diagnosed to ensure that the proper treatment plan and target area are selected. 

Regenerative spinal care is best at targeting disc pain in ways that physical therapy and surgery cannot. “The disc is the largest structure in the body that does not have its own blood supply,” said Dr. Bailey. “When we injure a disc, it doesn't heal up very well. It creates an environment that, over time, predisposes the disc to further degenerate.” 

Dr. Bailey primarily treats disc pain with platelet-rich plasma. In this method, platelets from the patient’s body are injected into the spine. Platelets are the body’s first responders to injury. By giving the injured area more platelets, the body’s healing responses are increased enough that the spinal injury can be healed well. 

Regenerative medicine on its own is not enough. Dr. Bailey recommends accompanying the treatment with physical therapy and exercise to prevent re-injury of the spine.

Excited to learn more? Tune in to this episode of Back Talk Doc to discover more about regenerative spinal care. 

Read the Full Show Notes on our website BackTalkDoc.com.

💡 Featured Expert 💡

Name: Dr. Peter Bailey

What he does: As a physiatrist at Carolina Neurosurgery and Spine Associates, Dr. Bailey is pioneering the field of regenerative spine care.

Company: Carolina Neurosurgery and Spine Associates

Words of wisdom: “If you have a patient who is younger to middle age, who has kind of a bad-looking disc, a surgeon doesn't really want to operate on that. Surgical outcomes for axial back pain are not that great. So it’s a great tool to have for that segment of the population that offers hope for the management of back pain, when it seems like other options aren't available. As far as the future goes, it's definitely going to be critical.”

Connect: Website |  LinkedIn 

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Back Talk Doc is brought to you by Carolina Neurosurgery & Spine Associates, with offices in North and South Carolina. To learn more about Dr. Lakhia and treatment options for back and spine issues, go to backtalkdoc.com. To schedule an appointment with Carolina Neurosurgery & Spine Associates, you can call us at 1-800-344-6716 or visit our website at carolinaneurosurgery.com.

Welcome. You're listening to Back Talk Doc, where you'll find answers to some of the most common questions about back pain and spine health, brought to you by Carolina Neurosurgery & Spine Associates, where providing personalized, highly skilled, and compassionate spine care has been our specialty for over 75. And now, it's time to understand the cause of back pain and learn about options to get you back on track. Here's your back doc, Dr. Sanjiv Lakhia.

On Back Talk Doc, I love to give numerous perspective on the care of your spine. If you haven't had the chance, please go listen to my most recent episodes where I've really hit the idea of back pain and spine care from different angles. We had the pleasure of interviewing Dr. David Schechter on the mind-body approach to pain. And then I follow that up with kind of two legends in the field of non-medical care of back pain, at least, with Esther Gokhale of The Gokhale Method, and then our most recent fabulous interview with Dr. Stuart McGill regarding more of a functional approach to back pain.

But as you all know, those who follow me, you understand I work in a premier neurosurgical practice and I have amazing partners, neurosurgeons and physiatrists, and I love to present their practice styles to you, the listener, so you can learn about what options are available. I think we have the best in the business, and obviously I have multiple amazing physiatrists that I work with.

Today, I want to circle back to a topic that we touched on briefly about a year ago with my partner Dr. Lesher, which is the idea of regenerative medicine. Today, I am very happy to interview my partner and friend Dr. Peter Bailey, and we're going to jump right into regenerative medicine, particularly for the spine. Peter, welcome to the show.

Thanks for having me.

All right. Let me introduce you to the listeners here. Dr. Bailey is a board certified physiatrist who did his medical school at the Medical College of Georgia. He did an internship in Salt Lake City, Utah, and then ultimately went on to do a fellowship in interventional spine and musculoskeletal medicine at The SMART Clinic in Sandy, Utah. Prior to that, his residency was in physical medicine and rehab at Mayo in Rochester, Minnesota.

He's board certified in physical medicine and rehabilitation and really is a leader in the field of interventional spine care in the Charlotte area and beyond. I know you've got a love and passion for thinking a little bit outside the box. For the last at least seven, eight years that I've been here, you've been leading our group or at least one of the leaders in terms of our foray into the field of regenerative spine care.

Start out by talking to the listeners about why you got interested in this idea of stem cells PRP regenerating treatments for back pain.

Yeah. Well, I think it kind of goes back to my undergraduate training to some extent. My background at the University of Georgia was in exercise and sports science or kinesiology as its referred to sometimes. It's all about how the body functions. I've always had an interest in kind of keeping people moving, continuing to participate in activities they enjoy, whether that's sports, work, what have you. As I kind of went through my training, this idea of entered to medicine or the field of regenerative medicine has kind of really taken off and grown a lot.

I was fortunate enough to be at the Mayo Clinic where there were some leaders in this field kind of emerging. I found it interesting. We're in a field where classically treatment of back issues or other musculoskeletal issues has sometimes been, well, you have surgery. You take pain medicines, or you use steroids. The emergence of regenerative medicine has kind of opened up an avenue essentially to kind of repair tissues using your own body's healing mechanisms.

It's been extremely interesting to follow and to be involved in and to see the results of people in real life that have done well with these treatments.

I know you really appreciate more of a holistic approach to the spine, and you've done a great job leading us in this field. But for those who are new to it, help them understand kind of what the target here is, and that is more specifically this idea of... Let's take low back pain as the example since it's kind of the focus of the podcast, but this idea of discogenic back pain. But what exactly is that?

Discogenic low back pain is pain related to the lumbar discs. You have discs throughout your spine, and they provide cushioning and flexibility to your spine. And for certain reasons over time, they can become painful. They can become painful through injury. They can become painful just kind of as what we call wear and tear. When we're born, the discs in our spine are about 80% water. And over time, as with a lot of tissues in our body, we lose hydration. And as we lose hydration, we become more prone to injury.

And when the discs kind of for lack of a better term start to dry out or dehydrate, they become more prone to injury. They can become painful because of small fissures or cracks in the disc. They can become painful due to injury, like a ruptured or herniated disc. And then we've also found, as you talked with Dr. Sumich, you can start to have endplate disc pain, which is kind of a whole other subject that you guys covered in good detail.

Yeah, it's important. Those that are listening to this podcast, I'm literally providing you almost with like an academic university-based education of back pain. Understanding where the pain is coming for from is very important in terms of selecting the right procedure. Again, if you haven't had a chance, go listen to the episode that I did with Dr. Sumich on vertebrogenic back pain. And then listen to the episode that I did with Dr. Stephanie Plummer facet mediated back pain.

When we talk about regenerative options for back pain, largely we're referring to disc related pain. And that's where these modalities like PRP and stem cells, the idea basically is you inject these different substances into an injured disc to help it repair itself. I'll give you an example. Tell me if you agree with this. If someone's listening to this right now and wondering, "Could I have disc related back pain?" To me, one of the most common complaints would be low back pain with bending over to tie the shoe or putting on your sock.

The outer rim of the disc is richly innervated and can become injured and fissured. And then when you bend, you aggravate it and kind of re-aggravate it. Is that something that you see a lot in your office?

For sure. I mean, I think some of the classic hallmarks of discogenic pain are, as you mentioned, difficulty with bending, lifting. Another classic is sitting intolerance. Any position that puts your spine in a flexed position where you're bending puts stress on especially the back or outer portion of the disc, where a lot of... Like you said, there's a lot of nerve endings in there that when stressed can become painful. You bring up an excellent point.

You mentioned some of the past episodes you've had regarding facet pain, vertebrogenic pain. Especially when it comes to regenerative medicine, you really want to identify, as you've mentioned before, the pain generator. I think with any procedure you do, you want to understand the source of the pain, that clinical history comes in, what type of things seem to aggravate the pain, the imaging, the physical exam.

It is especially important with regenerative medicine, because you've got kind of a shot to go at it and you want to get it in the right spot for sure. That's very important.

Absolutely. The diagnosis is almost as, if not more important, than the actual procedure. Because like you said, if you put that needle in a tissue and you do it perfectly, but that's not where the pain's coming from, it leads to disappointment, Absolutely. I know you do a whole host of things in your practice. For those of you who live in Charlotte or in the Concord area, Dr. Bailey, he's got every tool in his toolbox for trying to figure out what's going on.

But let's say you do have that person in your office and they've gone through some traditional treatments and you're pretty well-convinced it's a disc related pain. What are some of the options that they can consider from a regenerative medicine perspective? Just talk to them a little bit about what you offer and even what's out there in the broader community that you're aware of.

In my practice, I primarily do platelet-rich plasma. Platelet-rich plasma is a procedure where you essentially do a blood draw from the patient. You put the blood in a centrifuge, which spins the blood down, and you extract the platelets. And then you inject those back into the target tissue. The theory behind that is that the platelets are the... I call them the first responding cells in the body. They're the first cells to the scene when you have an injury. They come in. They cause the things to become sticky.

They clot, and then to signal other cells to come to the site and start to repair the tissue. You so platelet-rich plasma is the primary treatment I do in our practice. For one, it's a little less invasive than some other treatments. It's also less expensive than other treatments. And then some of the other options in the regenerative medicine world would be you've heard stem cell treatment or stem cell therapy. There's kind of two bags that that falls in. There's what we call allogeneic stem cell treatment and autologous stem cell treatment.

Allogeneic stem cell treatment might be what comes to some people's mind where you come in and you've got stem cells that have been grown in a lab somewhere and then inject it into your body. Now, that's not approved to do in the United States, so that's not really done here. There's been studies looking at that that we've done in our practice through Dr. Coric, who's one of our surgeons here. The other type is auto autologous, which means stem cells derive from your own body.

There are a couple of ways to get stem cells from your own body. One is a procedure called BMAC in short. It's short for bone marrow aspirate concentrate. It's a procedure where you essentially take a bone marrow sample from your pelvic bone. You concentrate that and you inject that back into a target area. Another way is to do a fat aspirate, almost like liposuction, where you take fat cells, where there are some stem cells to live in that area, and you concentrate that and inject that back in.

Those would be the primary sources of regenerative medicine where you have living cells that are injected in somewhere. There's embryonic fluids, preparations that can be used as well. But I'd say the primary three that are kind of the most exciting and most talked about would be the platelet-rich plasma, and then the other autologous stem cell treatments.

And contrasting those. Just to summarize, the platelet-rich plasmas or PRP, that is obtained through a blood draw. Pretty easy. The stem cells need to be harvested, and that can be either from bone marrow aspirate. Typically, like a big needle in the hip bone, right?

Yes.

Or the other mechanism could be almost through like a liposuction type procedure. Is that correct?

Yeah. Mm-hmm (affirmative).

There's varying degrees of invasiveness for obtaining the product. I think if you're considering this for yourself, you should consider this a factor in the decision-making process. But largely at the end of the day, the procedure itself to get it in the right spot is the same, right? I mean, you get the biologic agent and you're doing this under x-ray guidance to ensure accuracy and safety.

Mm-hmm (affirmative).

All right. Give us your opinion on of the state of the union, the state of the research with these sort of biologic agents that are out there. Kind of help people understand how long they've been around and where we've evolved and where we kind of still need to evolve in terms of demonstrating if these options are reasonable for people to consider.

Yeah. Well, I'd say that the area of regenerative medicine has really been kind of evolving over the last 10 to 15 years when it comes to treating humans. Now, back before that, a lot of the background from the field emerged from veterinary medicine it's been done on animals, especially race horses for a long time. I tell my patients that that's done and I say, "Well, horses don't lie. They either perform or they don't when they go out to pasture." The that's kind of where things evolved from.

I also discuss with my patients that the research is kind of slow to evolve in the area of regenerative medicine. For big studies to happen, there has to be money poured. And a lot of times, the money is poured in from drug companies or industry. When you have a product that essentially is just using your own body's healing mechanisms to heal itself, there's not a lot of funding. A lot of the research that comes along is kind of slower to evolve. It's happening.

There's a lot of good work being done, especially at New York University and some other areas. University of Utah, UCLA, a lot of good research going on, but studies over time have demonstrated positive results. Some of the endpoints that have been looked at would be satisfaction with having the procedure done. Would you do that again? Then also pain relief, disability improvement, that type of thing. Some of the more recent research that's been done was for intradiscal platelet-rich plasma injection.

It kind of demonstrated about 50% chance of over 50% improvement of back pain. It's kind of on the border, but there are still things that are being looked at as far as patient selection and that type of thing.

Dr. Bailey, what makes it so difficult for people to heal their disc injuries on their own?

Well, for one, the disc is the largest structure in the body that does not have its own blood supply. When we injure a disc, it's not like a cut in the skin where you've got a lot of blood flow to the area. When we injure a disc, for one, it doesn't heal up very well, and then it creates an environment that over time predisposes the disc to kind of further degenerate.

Once you injure a disc, there is not some intervention, whether that's physical therapy where you work on strengthen the muscle supporting the area, or if you try something like regenerative type procedure, it may just kind of constantly wear over time.

Yeah, exactly. I'm glad you mentioned that. I was thinking about the whole idea of really the poor blood supply. Most tissues in our body, when we have an injury, there's an inflammatory response, which is actually the healing response. People should understand that when you are injecting the biologic agent, whether it's the PRP or stem cell injections, you're almost trying to provoke the injury a little bit, and you're just trying to kickstart that natural healing response, which is suboptimal in the disc environment.

Yeah. That's what I tell people too. It's kind of like kickstarting or just rebooting the healing system. Just kind of intervening to a degree that's just not there.

And particularly as we get older.

Exactly.

All right. Now someone is in your office and you think they're a great candidate for an injection. Let's say PRP in the L5-S1 disc. Contrast their expect in terms of outcomes versus like a steroid injection. How is this different? What can they expect in the weeks and months ahead after an intradiscal PRP?

Okay. First, the discussion I have with them is that based on what we see and what we know, there's a chance that it may not be the best treatment for them. But if we decide to move on, I discuss kind of the natural evolution of that healing process. For one, it differentiates from a steroid injection, in that a steroid injection, we'll usually see improvement of pain almost right away. You might get a couple of days delay, but usually you have some improvement of pain almost immediately.

And then the effect of the steroid gradually wears off over time. When you inject platelet-rich plasma to the disc, it is a different process. You might actually have some increased pain for a day or a couple of days, a little bit of soreness. And then over time, the pain relief starts to kick in. We don't know exactly why some people respond in different ways. But in my practice, I've had people that were almost pain-free within a week, and I've had some people that had just gradually continuous improvement over the course of several months.

Sometimes use the analogy of like a cut to the skin. When you cut your skin, the platelets, like we mentioned earlier, kind of the first cells to the scene. They start to do some healing work. They start to do some repair work. If you kind of think of the way that works, you've got some bleeding at first. You get a little clot. You get a scab. You develop a scar. And over time that even smooths out. The whole healing process of when a platelet is introduced to a tissue takes about three months.

When I see patients, I will usually have them come back in a month to see how they're doing. And then again at three months to see where that looks like they might really settle out.

We're having a great conversation today. I'm talking with Dr. Peter Bailey about regenerative medicine for spine care. Thank you again for your time today, Pete. We've covered a lot of interesting information so far. What do you think moving forward, where is this all headed? There's two different camps. I know there's groups of providers who really don't think a lot about regenerative medicine. And in particular, there's potentially a lot of obstacles for this being adapted on a high level for spine care.

And then there's others who really feel like they're in the camp that this could be one of the initial treatments offered for people with discogenic back pain. You've been doing this a while now. What's your general sense about what we can expect in the next five to 10 years?

Well, I think awareness needs to grow. I definitely think you're right. I mean, there are some people that you bring up this idea and they just kind of dismiss it. There are other people who, who feel like it is kind of the only way to go, and I'm kind of in the camp where I'm in between, where I feel like it is a good tool to have, especially when it comes to discogenic back pain. I mean, in the past, even when I first started practicing, kind of like well, there's not much we can do.

If you don't respond to steroids, then you might have surgery or you might be on pain medicines. If you have a patient who is younger to middle aged who has kind of a bad looking disc, a surgeon doesn't really want to operate on that, and surgical outcomes for axial back pain are not that great. I feel like it's a great tool to have for that segment of the population that offers hope for management of back pain when it seems like other options aren't available.

I think as far as the future goes, I mean, it's definitely going to be critical. I'm going to start doing this in my practice for people that are doing this to gather information that demonstrates its effectiveness, getting disability ratings when people come in before and after, pain relief, and just keeping up with it. Because there's not a big industry that's funding this. I think it's up to the providers that are doing it to pay attention and to document its effectiveness.

Yeah, that's a great point. Particularly when we're talking about treatments that are maybe not covered by insurance and someone's going to have to come out of pocket for it, being able to prove efficacy, prove that it's a useful treatment is something over time that we definitely will continue to work on in the community. My general sense of it is that, it's like you said, I think it's a tool in the toolbox, and it's emerging option. Our group's philosophy has been really more in favor of the platelet-rich plasma.

I think the reason that is is for the following. Number one, in my opinion, there's a little bit more robust data just simply because it's been around longer. Number two, I think you would agree, it's a relatively low risk intervention. The risk of complications from intradiscal PRP are really small in the literature that I've reviewed. Number three, I think the ideal candidate, what you just said, it could be someone who's younger, maybe under 50, with discogenic back pain, one level disc issue, has done conservative care.

But boy, it's a leap of faith to ask them to go through a lumbar fusion that really nobody wants to do. I think for those reasons, it's a solid option. I'm glad that you offer it to our patients here. I think if you go into it with the right expectation, it's not the holy grail, but it certainly can give you some options and some hope that we didn't have decades ago for people with back pain. Like anything else, you have to, I believe, kind of couple it with a comprehensive approach.

My interview with Dr. McGill, he talked about the idea of picking the scab. Meaning if you don't kind of down regulate the pain sensitivity in your spine, you're going to have this perpetual cycle of pain. I think if you do a disc PRP, you want to work with a physical therapy team. You want to make sure you're hip-hinging properly, that you have good postal biomechanics, that you're not just only doing the disc PRP, but then continuing to aggravate it through improper activities every day of your life, because the outcomes there certainly wouldn't be as good.

Oh, I totally agree.

Yeah. Okay, very good. We've covered quite a bit of information today. I always like to close just by getting a little bit more personal. I know you. You've been into things like CrossFit. I know you have some favorite podcasts, and you stand on your feet all day, leaning over people, giving injections, lots of them. Number one, what do you do proactively to protect your back? And then number two, what do you think are important principles of just general health and wellness that you want to share with people?

As far as protecting my own back, I mean, when you see people with back pain every day and you kind of realize how that can impact your life, I think you kind of become very conscious of protecting your own back. The things I do, I mean, I think just generally, as you mentioned, health and exercising on a regular basis, but when it comes down to specifics, I think doing things with appropriate biomechanics, whether it's I'm lifting the blower to go do the leaves or something like that, just kind of paying attention to what I'm doing.

I think the times when people injure their back is when they're not paying attention to how they're moving. It's sometimes something that it's easy to lose kind of focus on. Just kind of being aware of movements and posture throughout the day. As far as specific exercise, I mean, when I tell patients when they come in to see me and they're like, "Well, what exercises should I do?" I mean, of course, I say, "A physical therapist is going to be your best friend when it comes to learning the appropriate exercises."

But if I had to say one, doing a proper plank or a bridge and seeing how you can improve that over time, as far as how you can hold a position like that. I think it's a great exercise for strengthening the entire core without a lot of risk of motion. That's kind of what I say as far as those type of exercises. I mean, I am a big proponent of you mentioned hip-hinging exercises. I think there are some exercises or weight lifts that kind of get a bad rap sometime.

But I think when done appropriately, exercises like dead lifts or kettlebell swings where you're really working on that hip hinge and the lumbar musculature are great exercises. I try to incorporate those on a regular basis into my exercise routine. As far as just kind of health and wellness, I mean, I kind of have a... Like you, I kind of like the area of longevity, medicine, lifespan. If we want to live long, we want to live well.

I think part of that is obviously kind of keeping your musculoskeletal system working well, but just overall doing things that are good to your body, whether that's eating appropriately, getting good rest, I know you're a big proponent of that, and learning how to do things that treat your body well.

Yeah, that's well said. I would add that everything that you just mentioned would support a PRP treatment.

Yes.

Meaning if you're going to take the leap and get a biologic injection of any type, you want to surround that with a healing environment, so getting proper rest, moving your body with proper biomechanics, working on your stress, and certainly putting proper fuel into your body so your cells can heal. All this goes together and I think you summarized it really, really well. I hope people listen to this, it piques their interest. Again, this podcast is not meant to diagnose nor treat your problem.

Certainly I don't want you running out and doing kettlebell swings because we said they're nice exercises. I mean, this is all just a starting point for people to kind of stimulate their thought process and have proper discussions with professionals out there. But I'm certain this is going to provide value for people who are contemplating their options. Really want to thank you for taking the time.

I appreciate you having me. It's been a good discussion.

Yeah, we'll talk soon. Thank you.

All right. Thanks, Sanjiv.

Thank you for listening to this episode of Back Talk Doc, brought to you by Carolina Neurosurgery & Spine Associates, with offices in North and South Carolina. If you'd like to learn more about Dr. Lakhia and treatment options for back issues, go to backtalkdoc.com. We look forward to having you join us for more insights about back pain and spine health on the next episode of Back Talk Doc. Additional information is also available at carolinaneurosurgery.com.