Lumbar Epidural Steroid Injection

What is bone marrow concentrate (BMC) therapy?

BMC therapy is a minimally invasive procedure that relieves pain and has been shown to promote long-lasting healing of musculoskeletal conditions using your body’s own cells and growth factors. [1] [2] [3] Research institutions and health care providers around the world have made tremendous scientific advances to make pain relief a reality, without the need for surgical intervention. As an Orthobiologics provider, your physician is able to take advantage of your body’s natural ability to heal by concentrating healthy mesenchymal stromal cells, also known as medicinal signaling cells (MSCs), that can be found in your bone marrow and other tissue sources.[1] [4] Laboratory and clinical research has shown that it is possible to use adult MSCs to restore function to degenerative joints and tendons. [4]

BMC therapy is a safe and effective treatment for a variety of conditions due to its autologous nature, meaning it is derived directly from your body for your treatment. [5] [6] [7] [8] [9]

What are MSCs?

Mesenchymal stromal cells (MSCs) are adult cells that can differentiate into different tissues (marrow, bone, cartilage, tendon, muscle and fat).[4] They are also capable of secreting signals to instigate a local immune and healing response. [4] MSCs, specifically derived from bone marrow, have been theorized to facilitate regeneration of tissue, enhancing the quality of cartilage repair and promote a healthy environment for repair and growth. [4] Bone marrow therapy is not only a powerful approach to arthritis but can be used for the treatment of ligament, tendon, cartilage and even bone healing issues such as avascular necrosis and bone lesions. [10] [11] [12] [13] [14]

Who should consider BMC therapy?

BMC therapy is a good option if you have failed more conservative treatments for musculoskeletal pain, such as cortisone or hyaluronic acid and would like to get back to an active lifestyle. [15] [16] BMC therapy may also be helpful to delay or avoid invasive surgery for non-retracted tendon/ligament tears or to stabilize a degenerative joint (such as delaying total knee arthroplasty). [17]

What can you expect during the procedure?

Bone marrow aspiration and treatment is a simple out-patient procedure that is typically completed in under an hour. Growth-factor and MSC-rich bone marrow is aspirated through a small point from your hip bone. These cells are then centrifuged and concentrated before being reinjected into the treatment area as a routine joint, disc or soft tissue injection. Discomfort is minimal and well-tolerated by patients.

What are the benefits of BMC therapy?

Minimally invasive, non-surgical procedure
Enhanced healing with your own natural healing factors
Extremely low incidence of side effects

Is there any downtime after a BMC procedure?

Many patients resume their activities immediately following the procedure. Some patients experience tenderness and mild bruising at the bone marrow aspiration site. There might be some mild soreness in the joint for up to a week after the injection. [18] Heavy exertion should be avoided during this period. Your provider will discuss specific limitations and rehab protocols with you before leaving the office as well as walk you through each step of your procedure, providing you with information including potential risks and guidance to maximize your recovery.

When can I expect pain relief?

Most patients show functional improvement at 3 months and continue to progress up to 6 months following treatment. [10] Favorable outcomes continue to be reported up to 5 years following treatment. [10]

What body parts and conditions can be treated with bone marrow?

Foot & Ankle

Chondral Defects [12]
Tendonopathy [19]
Ligament [19]
Open Fracture [20]
OA [19]

Spine

Discogenic back pain [21]
Degenerative disc disease (DDD) [22]

Shoulder

Partial and complete tear [3]
Rotator Cuff [23]
Tendinopathy [3]
OA [3]

Hip

Osteonecrosis of Hip [14]
Osteonecrosis of Femoral Head [15]

Knee

Osteoarthritis [24]
Chondral defects [13]
ACL tears [10]
Tendinopathy [17]

Are all bone marrow treatments the same?

If you are familiar with Orthobiologics, you may have heard of the terms Bone Marrow Aspirate (BMA) and Bone Marrow Aspirate Concentrate (BMAC or BMC). In both procedures, the physician will take some of your bone marrow. While BMA may be injected as soon as it is aspirated, research indicates that cellular yield and viability is not as high as reported by manufacturers. [11] BMAC/BMC, however, is centrifuged twice to separate and then concentrate the cells. [25] [26] Based on this clinical research, our practice only uses BMC for bone marrow treatments.

Does my insurance cover BMC therapy?

Although BMC therapy in musculoskeletal applications is well supported by clinical evidence, the broader use of BMC therapy in treating pain is still considered relatively new at this time. [1-3] [10-18] [21-30] Because of this, BMC is not typically covered by commercial insurance companies or Medicare, and is provided as a self-pay procedure. Our office staff can assist you with additional questions.

How much does BMC therapy cost?

The cost of BMC therapy varies based on the procedure performed. Our office staff can assist you with payment options and any other questions you may have.

Is BMC therapy FDA approved?

Treatments involving concentrated bone marrow, minimally manipulated bone marrow, for homologous use are not subject to FDA regulation as a human cell, tissue or cellular or tissue-based product (HCT/P); 21 CFR 1271.3(d)(4). Procedures involving the removal of an HCT/P from a patient and the implantation of that same HCT/P back into the same patient during the same surgical procedure are not subject to FDA regulation; 21 CFR 1271.15(b). The highly concentrated kits we use in this practice are FDA cleared (K183205).