Two years after my last orthopedic stem cell procedure for widespread joint and spine degeneration, the results are finally in.
This is my attempt to accurately convey my nuanced assessment of the results of my 2022 stem cell procedure, a task I find very difficult.
As others suffering from complex orthopedic pain conditions might know, rating your symptoms at all is hard enough, but rating their changes over time is even harder. Pain naturally waxes and wanes, and memories fade. But after two years, a pattern has emerged that’s stable enough that I can render an analysis I’m mostly confident in.
While my results have to be understood in the context of my uniquely complex case, they show the realities of how orthopedic stem cell treatments work—and don’t.
I think the procedure was mostly successful, which I say with varying levels of certainly across different areas.
Background
I have what I call whole-body osteoarthritis—degenerative joint disease in virtually all of my joints and degenerative disc disease at multiple levels spanning all segments of my spine. My condition started in 2006, and threatens my ability to do the two things in life that are most essential to me: work and exercise. Since 2016 I’ve had numerous regenerative medicine procedures with mesenchymal stem cells (MSCs) and platelet-rich plasma (PRP). This was my third, and possibly final, stem cell procedure.
The procedure involved intraarticular and intradiscal injections of autologous (my own) bone marrow-derived, culture expanded mesenchymal stem cells (MSCs) in many joints and discs.
The clinic I used was Regenexx Cayman, located in the Cayman islands. I had to get the treatment outside the US because the FDA prohibits culture-expansion of stem cells domestically. With culture expansion, the cells are grown in a laboratory to greater numbers, which is necessary to maximize potency and treat a large number of areas. The treating physician was Dr. Jason Markle, who has excellent procedural skills.
My bone marrow sample produced a disappointing stem cell yield—only 74.78 million MSCs. This limited the number of joints I was able to treat to a relatively small selection of the worst ones. Ultimately, we were able to treat 93 sites total across the spine, hands, and feet. This was a lot fewer than I wanted, but still meaningful.
Here’s a summary of the procedure:
Lumbar Spine
L5-S1 disc: Received 10 million mesenchymal stem cells (MSCs) and 0.5 mL of platelet lysate combined with high-concentration PRP.
Facet Joints (L1-S1): Received a total of 10 million MSCs and 10 mL of platelet lysate, distributed across all facet joints from L1 to S1, with approximately 0.5-1 mL per joint.
Thoracic Spine
Facet and rib facet joints (T1-T12): A total of 6 million MSCs and 6 mL of platelet lysate combined with PRP were distributed across all thoracic and rib facet joints from T1 to T12.
Thoracic discs (T4-5, T5-6, T6-7, T10-11): Each disc received 6 million MSCs and a mixture of 0.5 mL platelet lysate and high-concentration PRP.
Cervical Spine
Facet joints (C0-T1): A total of 8.48 million MSCs and 8 mL of platelet lysate were distributed across all facet joints from C0 to T1, with approximately 0.5-1 mL per joint.
Cervical discs (C3-4, C4-5): Each disc received 5 million MSCs and 0.5 mL of platelet lysate combined with high-concentration PRP.
Hands and Feet
A total of 6 million MSCs and 6 mL of platelet lysate, mixed with high-concentration PRP, was evenly distributed across the largest thumb joints in both hands (1CMC and 1MCP), the ankle joints (tibiotalar), the subtalar joints, the calcaneocuboid joints, and the toe joints (1st, 2nd, and 3rd MTPs) bilaterally.
Recovery
My recovery from the procedure was tumultuous. The L5-S1 disc injection caused a massive, prolonged flareup that was initially debilitating, while the other parts of my spine felt soothed by the treatment. The treated joints in my hands and feet were very sore for a few days, but the pain was manageable and resolved quickly.
To allow my joints to recover, I ceased all high-intensity exercise but resumed light walking as soon as possible.
In most of the treated synovial joints, I noticed rapid initial changes—a “smoothening” of the joint surfaces, which I interpret as indicative of cartilage regeneration. However, these changes were extremely fragile, and even everyday activities aggravated the joints and un-did the early improvements. I was dismayed by how little stress the recovering joints could withstand without incurring damage and deteriorating again. While I found that they had a potential for recovery, after 4-5 significant setbacks in the first six weeks, I felt I had lost much of the benefit in most areas, and was demoralized.
After those early setbacks, I spent most of the first year feeling disheartened. 3-6 months out, I did note some improvements, but felt the overall outcome was underwhelming. The L5-S1 disc was still worse than before the procedure, and even the improved joints were fragile. I observed smoother movement and pain relief in the synovial joints of my thumbs, feet, and cervical spine, but could not tell whether any of the disc treatments were working at all.
My feelings about the outcome shifted over the months, but I had a prevailing sense of disappointment. I had to remind myself that I did feel tangible improvements in some areas. I kept fighting to salvage whatever potential the procedure still had, trying to balance light activity with the need to protect my joints from damaging stress.
Nine months out from the procedure, I cautiously introduced high intensity exercise. This led to increased pain at L5-S1, but other areas remained stable.
Around 1 year out, I unexpectedly began to feel that key parts of my spine were feeling better most of the time. I stopped being so careful and was able to resume my pre-procedure habits without any adverse consequences. The L5-S1 disc remained sensitive, but was settled down most of the time.
Results at two years
I’m now two years out from the procedure, and the improvements I noted a year ago have been mostly stable since. However, I still have some uncertainty about judging the results, which involves answering two hard questions:
- How do I feel now? Even this is hard to answer because I have many overlapping regions of pain, and I find it almost impossible to rate any of them meaningfully or consistently. On a scale of 1-10, my pain is “go fuck yourself.” The pain also changes over time and is strongly influenced by what I’ve done recently.
- How did I feel before the procedure? I don’t have a snapshot of my pain before the procedure to compare my recent status against.
My vagueness on these questions makes it hard to tell whether the remaining pain stems from incomplete resolution in the treated areas or the presence of untreated pain generators nearby. All of the treated areas are surrounded by closely associated joints that also hurt, and we only treated a portion of them.
But with that said, I do perceive some significant—if not major—differences.
Thoracic spine
My thoracic spine stands out as an area that did very well.
The pain in my T-spine seems significantly less intense and widespread than before. I used to have a searing bolt of pain that ran down the upper left side of my back—this seems to have gotten a lot better, though small regions of it remain.
I still have pain in several parts of my T-spine, but I think it’s coming from the parts that didn’t receive treatment. The change is impactful enough that I can say this segment of my spine feels much better most of the time, with a definite downtrend in pain.
I mainly attribute the improvement to the intradiscal injections in the area, but some of it may be a result of the cervical treatments, as cervical stenosis can cause referred pain in the thoracic area.
I had a six month followup MRI, but can’t compare them myself due to what seems to be an excessive difference in positioning, nor did I have my Regenexx doctors review them. But check out this nifty, crude illustration of the pain before versus after.
Cervical spine
The cervical spine is a more complex assessment. Notably, we left the anterior facet of C1-C2 untreated due to its inaccessibility, which is significant because it’s an important joint.
I have noted some clear improvements—particularly in the cervical facets, which seem significantly improved, indicated by reduced friction and crepitus during joint movement. Previously, subtle side flexion and rotational movements produced a coarse grinding or “catching” sensation, but this seems much better now.
Additionally, I seem to experience significantly less pain in the middle and lower regions of my neck most of the time. Before the procedure, I had a constrictive sensation I called “the noose,” as well as tingly “pinching” sensations in my mid neck. These were nearly constant before, but occur much less frequently now.
However, the upper cervical area remains quite painful. I suspect this pain comes from the median atlanto-axial joint, the one we couldn’t inject due to its unique orientation to the spinal cord. This has gotten worse since the treatment. The pain in this area emanates in a way that makes it hard to tell exactly where it’s coming from.
Unfortunately, even the cervical areas that improved are still vulnerable. Recently I tried to increase my exercise intensity, and managed to sustain it for a few weeks, but had to back off when I noticed a worsening, particularly of the crepitus—an indicator of deterioration in the facets. While the joints have improved, they are far from normal.
Despite the symptomatic improvement, there were no evident changes in either of the discs on MRI six months out. I don’t have the skills to assess facet images.
Lumbar spine
In the lumbar spine, the treatment was a failure as far as I can tell.
The flareup from the injection at L5-S1 introduced what seemed to be a new locus of pain, which makes me think the disc was actually asymptomatic before, and the treatment made it hurt for the first time.
The initial flare gradually settled into a sustained general worsening that lasted a long time. Recently it hasn’t hurt very much, so it’s almost back to baseline. But unlike before, it’s vulnerable to flareups. The facet joints are still sensitive, especially when my back is pressed into the backrest of a chair.
There was no change on MRI at six months post-procedure. The annular tear didn’t even resolve, and that’s supposed to be the low hanging fruit of intradiscal orthobiologics.
Hands
In the hands, we treated two joints in each thumb—the 1CMC (base of the thumb) and 1MCP (middle joint)—only a small subset of the joints in the hands that need it, even leaving the interphalangeal joints in each thumb untreated.
Still, these joints seem better. I can hit the spacebar on the keyboard more comfortably, although the untreated distal joint of the right thumb still hurts when I do.
While I can’t compare the before and after MRIs of my hands directly because of how difficult the images are to interpret, there is a difference between the reports from my 2020 and 2023 hand MRIs. On the 2020 hand MRI report, the radiologist noted joint space narrowing in the 1CMC and 1MCP joints bilaterally. But the 2023 MRI report did not indicate any such finding, and denied erosion of any of the joints. I have the impression that MRI reports often aren’t very thorough, so I don’t grant this much significance.
Feet and ankles
The joints of the feet and ankles we treated have definitely improved—no doubt about it.
I can feel what seems to be cartilage regeneration, as indicated by smoother joint movement in my ankles and subtalar joints. Interestingly, because we treated some toe joints but not others, there’s a clear contrast between the treated and untreated ones, like a built-in control group.
The improvement allows me to walk with a lot less pain in my subtalar joints.
Previously, I had experienced repeated treatment failures in my feet, making this the first success.
Unfortunately, these improvements are still fragile. They survive everyday activities, but heavy loading causes the joint surfaces to deteriorate again. I recently tried to incorporate bodyweight squats into my workouts, but even that mild strain was enough to worsen the joints of my feet.
There were no MRIs of the feet before or after.
Overall impact
While I believe most of the treated joints improved significantly, the question of the procedure’s impact on my overall functional ability is harder to answer for sure.
Some areas have improved with treatment, but others—particularly untreated ones like the upper cervical area and the non-treated joints in my hands—have worsened since 2022.
In 2021–2022, I recall feeling like I was teetering on the edge of disability. I already felt unfit to work, and was doing a lousy job, but stoically pushed through, hoping to hold on long enough to make a little more before filing an inevitable long term disability (LTD) insurance claim. I was resigned to this fate and the expectation of adopting a lean lifestyle. I had little in the way of further goals or ambitions, and smoked pot to evade reality.
Since then, I’ve seen some pretty significant changes. I seem to have pulled back from the edge of disability. Although I still have serious problems, if my fingers hold up, I feel able to continue working for now. There’s been an improvement in my performance—my tonality when talking to people has improved, and I’m able to be more personable and patient most of the time. This was a subtle change that came about without me realizing it.
Beyond work, I’m re-engaged with life. I not only want to keep working as long as possible but also find a way to progress beyond my current job, even against the odds. I maximize my time outside of work as well.
Some of these changes might be the result of my own effort, but I truly believe a lot of it stems from the pain reduction in the most critical parts of my spine.
I still have bad days and stretches, and in those moments I’m less positive about the outcome, but those moments seem relatively few and far between.
My ability to exercise is mostly unchanged. Despite improvements in some areas, I still have the same restrictions due to my whole-body condition and the risk of making the joints worse if I do anything too aggressive. However, I can do the same level of exercise—my cherished Timed Static Contraction (TSC)—with less spine pain, a meaningful improvement.
Post procedure missteps
Post-procedure joint protection has consistently proven to be a significant factor in my treatment outcomes. In previous treatments with both stem cells and PRP, excessive loading in the first few months caused setbacks—and in the case of my second stem cell procedure in 2018, completely botched the treatment. Unfortunately, this experience was no exception.
The clinic’s guidelines for lumbar intradiscal rehab instructed not to lift more than five pounds for the first six weeks—a restriction I found nearly impossible to follow. Dr. John Pitts, who authored these guidelines, said in an email that the 5 lb limit is arbitrary, and if it didn’t hurt before the procedure, you can do it shortly afterward. But I found that guideline too liberal, as even activities that had been manageable pre-procedure caused setbacks.
I tried to be as careful as possible, and refrained from intentional exercise, but my life is full of hazards of everyday living. Two weeks after the procedure, my father fell ill and lost his strength, putting me in a position to have to pick up the slack for two disabled family members.
I recorded four major “damaging incidents” in the first six weeks, and more as time went on. They were all stupid, impulsive actions that I could have avoided if I had been cautious like my life depended on it. On the 15th day, while under the influence, I lifted an 18lb box off the front porch and carried it inside, causing aggravation and damage. Six weeks out, I pushed a small utility cart carrying my computer equipment a short distance at work—I was shocked that this catalyzed a massive flare and the biggest setback I experienced.
I was also about 15 lbs overweight at the time of the procedure. This definitely didn’t help anything, given that lifting 15 lbs proved excessive on multiple occasions.
I believe this pattern of inadequate post-procedure activity restriction and being overweight undercut the treatment success. The L5-S1 flareup made the disc more vulnerable and mandated short-term protection, and I didn’t give it enough of that.
Conclusion
I was too lazy to write a conclusion, so I asked Chat GPT to write one for me (I wrote the rest myself, I swear!). Here's what it kicked out:
At two years out, the results of my procedure reveal both significant improvements and lingering challenges. While some areas—like my thoracic spine and feet—showed meaningful gains, others, particularly my lumbar spine, remain problematic. The improvements I’ve seen are real but fragile, requiring careful management to preserve them.
Despite my ambivalence about the extent of the success, I believe this procedure has given me a better quality of life than I would have had otherwise. Looking forward, the lessons from this experience will inform how I approach managing my condition and making decisions about my care. For now, I’ll take the progress I’ve made and continue building on it as best I can.
