Often my colleagues and I share interesting referrals in my physiatry department that we receive from primary healthcare providers . Recently, one of my colleagues received a referral that read “No MRI imaging available. Patient has classic spinal stenosis and sciatica symptoms. Referring to you for regenerative treatment.“
Why an Accurate Diagnosis Must Come Before any Regenerative Treatment
As a spine pain specialist, this was a confusing referral. Firstly, spinal stenosis and sciatica are quite different diagnoses. In fact, sciatica is nothing more than a description of a symptom. Sciatica simply means that there is nerve pain travelling down the leg. There are myriad conditions that can lead to nerve pain travelling down the leg. When we attribute nerve pain down the leg to spinal stenosis, we call this neurogenic claudication. Neurogenic claudication has a very specific pattern and is really the only consistently attributable symptom to spinal stenosis.
The key to any successful treatment is an accurate diagnosis. Even after treating thousands of cases of back pain, I would be hard-pressed to definitively diagnose a classic spinal stenosis or sciatica condition simply by the patient’s presenting symptoms. Sure, I could make an educated guess, but when it comes to spine pain, particularly spine pain that involves radiating pain, it is nearly impossible to have an accurate diagnosis without advanced imaging such as MRI or CT scan. Advanced imaging is really the only way to diagnose a disc issue or other structural anomaly that might be impinging on or irritating a nerve at the level of the spine. That is why here at ORM we recommend an MRI for all our spine patients with radiating symptoms. Once we identify the issue, then we can focus on the regenerative treatment tools we have to treat them.
From Steroids to Biologics: Rethinking what treatment can look like
Traditionally, treatment has meant either a steroid injection, nerve ablation, or surgery— but at ORM we have a much broader range of regenerative treatment tools available to us. There is still a role for steroid injection when it comes to acute disc extrusions. I won’t hesitate to provide a steroid injection for an acutely extruded disc impinging on a nerve that is causing significant functional limitation. However, for chronic radiating leg pain and low back pain- the possible benefit from the use of epidural steroid injections does not outweigh the risk associated with these procedures, as noted in Dr Peterson’s article, Expert Panel Advises Against Common Low Back Pain Treatments.
In contrast, PRP epidural injections have been shown to be beneficial in treating chronic pain of lumbar disc origin, even after 12 months- as demonstrated in a recent study.1 On average, pain scores decreased from a level 8 down to a level 5 on a 10-point pain scale at the 1-year mark after treatment. In another recent study,2 individuals with neck whiplash associated facet and disc pain found a 65% improvement in pain symptoms after 12 months.
Long-Lasting Results through Precision and Personalized Care
Research continues to demonstrate that our regenerative treatments are not only effective, but they are also long-lasting. Unlike conventional interventions that may offer only temporary relief—or none at all—regenerative treatment options like PRP target the underlying tissue damage and promote true healing over time. This is especially valuable for patients with chronic symptoms who may have exhausted traditional therapies without meaningful improvement. At ORM, our approach integrates diagnostic precision with biologic therapies tailored to each patient’s condition, ensuring that treatment is not only evidence-based but also personalized. As we continue to monitor long-term outcomes and refine our techniques, we remain committed to offering safe, minimally invasive solutions that help our patients return to fuller, more active lives.
Dr. Kristian Flores, MD, ND, began his medical journey as a Naturopathic Doctor. He then earned his Medical Degree, completing an Internal Medicine internship as well as a residency in Physical Medicine and Rehabilitation (also known as Physiatry). As a Board-Certified Physiatrist, Dr. Flores specializes in the prevention, diagnosis, and rehabilitation of people disabled by disease, disorder, or injury. He works extensively with patients suffering from acute and chronic pain conditions such as spine pain and sports injuries. His practice also includes helping patients with disabling conditions such as brain injury, Long-COVID, and hypermobility disorders.
Sources
- Playfair D, Smith A, Burnham R. An evaluation of the effectiveness of platelet rich plasma epidural injections for low back pain suspected to be of disc origin – A pilot study with one-year follow-up. Interv Pain Med. 2024;3(2):100403. Published 2024 Apr 3. doi:10.1016/j.inpm.2024.100403
- Smith A, Andruski B, Deng G, Burnham R. Cervical facet joint platelet-rich plasma in people with chronic whiplash-associated disorders: A prospective case series of longer term 6- and 12- month outcomes. Interv Pain Med. 2023;2(1):100237. Published 2023 Feb 27. doi:10.1016/j.inpm.2023.100237
