A common source of MSCs is the bone marrow, especially from the iliac crest. The iliac crests are subcutaneous and are easily palpable, thus making the stem cells harvesting process easy. Bone marrow is aspirated from the region of posterior superior iliac spine and the MSCs contained within the bone marrow are used by concentrating the aspirate so as to use the natively available stem cells in addition to the growth factors within the ultrafiltrate. The final product is a concentrate that has approximately 5-10 times the baseline levels of regenerative cells and growth factors. This treatment can be done in isolation or in combination with surgical application to stimulate and enhance the healing process. Most patients notice some level of improvement by 2-6 weeks following BMAC treatment. Increased stability and strength are typically reported along with the decrease in pain. Patients are encouraged to remain active with a functional rehabilitation program and strengthen surrounding muscles during this period.
How it is performed?
The process is a simple 60-minute procedure done by your treating physician in an office setting. The pelvis is landmarked with use of an ultrasound machine, and adequately anesthetized locally and cleaned. Bone marrow is extracted from the back of the patient’s pelvis from an area called the posterior iliac crest with the use of a special cannula. A syringe collects the bone marrow, after which it is filtered and spun in a special centrifuge. The concentration of stem cells and healing components, collectively known as the bone marrow concentrate, are reintroduced to the injured area. This is combined with PRP at the time of injection. Once introduced at the site of injury, it is theorized that the platelets release growth factors that tell the regenerative cells what to become, thereby initiating the regenerative response. Soreness at site of injection is common but ambulation is not restricted after the procedure. This soreness usually resolves on its own within a few days after the injection.
What are the Risks?
While there is some slight discomfort, most patients tolerate the procedure very well and with minimal pain. The procedure is done under local anesthesia to minimize any discomfort. Post-injection soreness at the injection site is sometimes present because of an inflammatory response caused by BMC therapy. It is important that non-steroidal anti-inflammatory medications (NSAIDS) such as Ibuprofen, Naproxen and Aspirin be avoided following treatments because these medicines may block the effects of the intended healing response facilitated by the post-injection inflammation. Additionally, all blood thinning agents must be stopped prior to and shortly following the procedure to minimize bleeding and subsequent side effects. It is acceptable to use pain medication such as Tylenol, and in some cases a prescribed pain reliever, which does not have anti-inflammatory properties, to control discomfort as needed.