Dr. Francisco José Castilla explains that regenerative therapies in the field of orthopedic surgery are becoming increasingly popular, which leads to a greater demand for their use and, therefore, also for research and studies to support their use and the effectiveness of their results. To date, the indications for the use of these treatments are degenerative pathologies, which either because they cause pain in daily life, or because of the limitations they produce for the practice of certain jobs or sports activities, are a frequent cause of medical consultation. They are also the most prevalent pathologies. For years, much experience has been gained in the use of plasma rich in growth factors (PRGF or PRP).
What does regenerative stem cell therapy consist of?
This technique consists of centrifuging the patient’s own blood and extracting the part of the plasma with the highest concentration of platelets. The platelets are then activated with calcium chloride to release their content, which is very rich in growth factors that favor the growth of new vessels and the differentiation of certain undifferentiated cells at a local level, which makes it useful in the healing of chronic tendinitis, torpid ulcers, favoring bone consolidation, etc. They act as “signals” to enhance or initiate physiological regenerative phenomena. One of their disadvantages is that it is often necessary to apply them in several sessions and that their response is unspecific. Even so, their usefulness has been demonstrated in many of these processes and they continue to be used as a treatment or as an adjuvant. Taking these therapies a step further, treatments with pluripotent cells or “stem cells” are making headway.
What are stem cells?
We all have these cells in all our tissues. They are responsible for repairing lesions in each tissue when necessary, differentiating into specialized cells of the tissue to be repaired when stimulated by the release of substances present in an inflammatory process. The repair capacity is mediated by the correct differentiation and, of course, by the number of cells involved. These factors are negatively mediated, among other things, by age. Therefore, it seems increasingly important to provide not only “signals or inducers” but also “multipurpose workers” with the capacity to differentiate. The more the better.
How to achieve a high concentration of stem cells?
Firstly, by extracting them from tissues where we know they are present in greater numbers. Currently this is done from adipose tissue or from iliac crest hematic tissue. And secondly, by concentrating them in order to discard the material that is not useful, especially when the area where they are to be implanted is small. It is convenient to have the maximum number of these cells in the smallest possible volume.
What pathologies can it solve?
In the field of orthopedic surgery they can be used mainly in osteoarthritis, to regenerate the maximum possible cartilage lost by this process. Also in some bone lesions of vascular origin, such as osteochondral lesions in the knee or ankle and in avascular necrosis of the hip. And specifically in spinal pathology, a new horizon is opening up in the treatment of disc pathology. Cases of herniated discs with intense pain in MMII (Sciatica) or with neurological deficit, usually require surgical treatment, but lesions that do not cause great pain in the legs, or in cases of disc protrusions or painful black (dehydrated) discs, which cause most of the chronic low back pain, can be treated by this technique. Specifically, we propose the injection of an iliac crest concentrate, extracted and injected under sedation with radiological control in the operating room as a treatment for some of these lesions.
Prognosis of regenerative stem cell therapy
In the future, improvements will be discovered in the capacity to concentrate a greater number of these cells and in the orientation of their differentiation, but at present, studies already support their potential for clinical and radiological improvement. For more information, you can consult with a specialist in Traumatology.