Regenerative Medicine Procedures, Platelet-Rich Plasma (PRP) Therapy

This article is a continuation of Regenerative Medicine and Stem Cell 101. Here, you’ll learn who performs stem cell treatment, the procedures involved, platelet-rich plasma, the role of the U.S. Food and Drug Administration (FDA), insurance coverage, and sample cost information.

platelet rich plasma graphicPlatelet-rich plasma is obtained from the patient’s own blood.

SpineUniverse: What specialists perform stem cell therapy?
Dr. Kamhi: While oncologists are involved in transplanting bone marrow to treat certain types of blood cancer, orthopaedic physicians and interventional pain specialists may use autologous (the patient’s) adult mesenchymal stem cell transplantation (or infusion) to help repair muscle/tendon injuries and replenish cartilage (eg, osteoarthritis).

SpineUniverse: What does the stem cell treatment procedure(s) involve?
Dr. Kamhi: The procedures associated with stem cell treatment involve strict sterile techniques. This means the medical team takes every precaution to keep the patient and the entire process free from infectious elements. Patients are sedated, as needed, for comfort.

Stem cell treatment consists of 3 steps:

  1. The physician harvests/retrieves stem cells from bone marrow using a special instrument called a trochar (or trocar). The physician uses real-time x-ray (eg, fluoroscopy) to guide the trochar into the proper position and then collects the stem cells from the bone marrow. Fat cells are collected using liposuction.
  1. The stem cells are concentrated and mixed with growth factors that are obtained from the patient’s own blood plasma. This is performed in an on-site laboratory.
  1. Using ultrasound or fluoroscopic guidance, the stem cell-growth factor mix is injected into the precise part of the body.

Each step takes about an hour, so the entire procedure usually takes 3 hours.

SpineUniverse: What is platelet-rich plasma (PRP)? How is it used?
Dr. Kamhi: Platelet-rich plasma is obtained from the patient’s own blood. In the laboratory, a centrifuge is used to separate the proteins from the cellular elements in the blood.

Some physicians retrieve the PRP alone from the patient. After processing the PRP, they inject the PRP without stem cells, assuming the patient’s own stem cells will respond and stimulate accelerated healing. Other physicians prefer to retrieve both PRP/growth factors and the patient’s stem cells at the same time and inject the mixture.

SpineUniverse: Are there specific areas of the body that can be treated?
Dr. Kamhi: Commonly treated areas include the shoulder joint (eg, rotator cuff/tendon tear), torn ligament within the knee, elbow, ankle, or hip joint. More recently, attention has been given to degenerated or injured spinal intervertebral discs.

A double-blind, randomized study showed that injection of PRP, when compared with a control injection in single and multiple degenerated spinal discs, was superior in providing pain relief and increased function.1

SpineUniverse: Are there risks related to adult stem cell/PRP treatments?
Dr. Kamhi: As with any medical procedure, there is a potential risk for complication or unsatisfactory outcome. Practically speaking, risks in any invasive procedure include infection and/or inadvertent injury.

Several factors can improve overall success of stem cell treatment:

  • Physician experience and skill
  • Patient selection (the patient’s overall health, diagnosis, appropriateness of the procedure)
  • Abiding by strict sterile techniques throughout the entire procedure(s)

Physicians should discuss the potential risks and complications with a patient before the procedure. An informed consent document contains this information, which the patient signs before undergoing the treatment.

Patients should understand that there may be appropriate alternative treatment(s) as well. Patients are given ample opportunity to research their diagnosis and the recommended treatment, so they can make a decision that’s right for them.

SpineUniverse: Are stem cell and platelet-rich plasma (PRP) injections typically covered by Medicare and other health insurance plans?
Dr. Kamhi: While some Medicare plans cover stem cell transplants under certain conditions, Medicare does not cover treatments for degenerative conditions—such as those related to the spine.2 Stem cell and/or PRP procedures are also not currently covered under most commercial health plans.

As research advances, results improve, techniques become more widely known, and patient demand for coverage grows, insurance plans may make coverage for regenerative medical procedures available.

SpineUniverse: What do stem cell and PRP procedures typically cost?
Dr. Kamhi: Costs are determined by the treating physician and the patient, they and vary by treatment facility. An impartial volunteer queried a center in Arizona and another in New Jersey: Procedural costs ranged from $4,900 to $7,000.

Regenerative medicine procedures are physician- and equipment-intensive, which contributes to the costs of the procedures. To alleviate the financial burden on patients, many clinics provide extended payment plans and/or related financing to patients who request the courtesy.

Patients may also seek advice from their tax specialist and/or financial planner about medical expenses not reimbursed by their health insurance plan. Possibly, the medical expenses can be deducted from their federal tax filing.

Off-label Statement: The U.S. Food and Drug Administration (FDA) has not approved stem cell-based products, except for blood-forming stem cells used to treat certain types of cancers.3 When certain products (eg, platelet-rich plasma) are used by a medical professional, its use is termed “off-label.”4

Updated on: 05/24/18
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Stem Cell Therapy and Spine Care

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