HEAL YOUR DISC, END YOUR PAIN
How Regenerative Medicine Can Save Your Spine
In Heal Your Disc, End Your Pain, RSI+ founder Dr. Gregory Lutz shares his groundbreaking research and practical experience using regenerative medicine to treat patients with chronic back pain safely and effectively—without drugs or surgery.
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All proceeds from sales of Heal Your Disc, End Your Pain, benefit the Regenerative Sportscare Foundation (RSF), a 501(c)(3) charitable organization, whose mission is to cure low back pain.
To Paula,
my love and inspiration
Dr. Gregory Lutz and Paula Lutz photographed at the Regenerative Sportscare Institute on December 12, 2022
While the pandemic was tragic, the shutdown gave me time to think, reminding me why I became a physician and what I find so compelling about this noble profession—caring for patients and helping them heal from their wounds.
A NOTE TO YOU
I've never written a book before. I always wanted to but just never had the time. Between balancing a very busy clinical practice and family responsibilities, there was no chance to stop, collect my thoughts, and write. I’m sure there are many physicians who feel that way during their careers.
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In their decades of clinical experience managing patients with a specific medical condition, they learn something special that maybe no one else has yet noticed, a “nugget” of information that could potentially change the treatment paradigm for that condition and make life better for everyone. But due to their busy schedules or lack of resources, they are never able to share their discovery beyond the walls of their own practice.
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That could have very well been my story, too, if not for COVID. My clinical practice was directly in the middle of it, in the heart of New York City, and the pandemic was a terrible experience for us all. We were shut down for over three months by state mandate because all healthcare resources had to focus on addressing the virus.
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Without that pandemic pause, I don’t think this book would have been written. It created the “hard stop” that finally gave me the time I needed to share with you my nugget of wisdom regarding how I believe we can better manage back pain.
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While the pandemic was tragic, the shutdown gave me time to think, reminding me why I became a physician and what I find so compelling about this noble profession—caring for patients and helping them heal from their wounds.
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We endure many types of “wounds” in life—psychological, emotional and physical. The wound you’ll learn about in this book is in your spine, more specifically in your disc. I’ll explain that chronic lower back pain is usually nothing more than an unhealed wound in your disc, which can be treated simply and effectively with your own cells. Not drugs, not surgery—just your own cells. That is the nugget I would like to share with you. Hopefully, this knowledge will help you or a loved one find an answer to your chronic lower back pain.
ILLUSTRATIONS FROM
HEAL YOUR DISC, END YOUR PAIN
FIGURE 1
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This is how PRP is prepared. We draw your blood and place it into a centrifuge, and the cells of the blood are concentrated and separated into different layers. Erythrocytes are your red blood cells and go to the bottom of the tube. Then there is the buffy coat, which is composed of white blood cells and platelets. Plasma is the protein portion of the blood. We can now aspirate the concentrated platelets and white blood cells into the plasma to make the PRP to inject.
FIGURE 2
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The MRI image on the left is a side view of James’s left ankle showing a large tear of the Achilles tendon (arrow). The area of white inside the black tendon is the tear. The MRI image on the right is James’s left ankle six months after his PRP injection showing a completely healed Achilles tendon (arrow). A normal tendon should look completely black on the MRI.
FIGURE 3
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This is an illustration of the anatomy of the lumbar spine. The intervertebral disc is sandwiched between the bones in the spine called the vertebral bodies. The gelatinous center of the disc is called the nucleus pulposus. This is contained by circular rings called the annulus fibrosus. The spinal nerves rest in the spinal canal behind the disc.
FIGURE 4
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This is a fluoroscopic image (low dose X-ray) of Jennifer’s injection into her discs of contrast (called a discogram). The images on the left are the needles placed into the two lower discs (L4-5 and L5-S1) without contrast injection. The images on the right are after contrast injection (black fluid inside the disc). In a normal discogram the contrast should stay in the center of the disc (the nucleus pulposus) and not leak out (L4-5 is normal). If you look closely at the lower disc, there is a faint black line of contrast (arrow) outlining the back of the disc that represents a tear of that disc (L5-S1). If the patient experiences similar pain to what they normally have (what is referred to as concordant pain) when we see the tear fill with contrast, then that is an abnormal discogram. The discogram helps us confirm the diagnosis of what is referred to as internal disc disruption when the MRI is inconclusive. We then injected PRP to trigger the healing response inside the disc to relieve her pain
FIGURE 5
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These are magnified MRI images of Jennifer’s lumbar spine from a side view (sagittal views). The image on the left is before PRP treatment and shows a white line in the back of the disc (called a high intensity zone [HIZ]). The HIZ on the MRI represents a tear inside the disc. The image on the right shows the HIZ healed three months after PRP treatment.
FIGURE 6
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This is an illustration of the progression of a disc herniation from normal, to protruding (an incomplete tear), to an extrusion (a complete tear), to a sequestered disc (a fragment of disc material in the spinal canal), creating injury to the spinal nerve.
FIGURE 7
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These are Wendy’s MRI images of her lumbar spine over time. The top images are from 2013 when I first saw her, and the bottom images are from 2021. The MRI images on the left are looking at the spine from the side (sagittal T2), and the images on the right are cross-sectional images (axial T2). Note how the second from the lowest disc (L4-5) on the top view has a small tear and disc protrusion. The images on the bottom reveal the progression of disc degeneration over time with traditional conservative care. This resulted in narrowing of the spinal canal (stenosis), slippage of the spinal segment (spondylolisthesis), and led to her having major spine surgery to relieve her symptoms.
FIGURE 8
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These are Jeff’s CT scan images of his discogram. The images on the left are a cross sectional view (axial) from the second lowest disc (L4-5) where we see the contrast dye (white) leak out of the periphery of the disc (grey). The CT scan images on the right are a side view of the spine (sagittal) showing the contrast dye leaking out of the back of the L4-5 disc.
FIGURE 9
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These are Jeff’s sagittal T2 MRI images. The MRI images on the left are from 2010, pre-treatment, and the images on the right are from 2021. There were no signs of disc degeneration at the L4-5 level over an eleven-year period post-PRP treatment.
FIGURE 10
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Depicts the stages of normal wound healing.
FIGURE 11
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At left is an SEM (scanning electron microscope) image of a titanium bone screw at low magnification. At right is a high magnification SEM image of the region highlighted, showing the presence of bacterial contamination on the implant. (Courtesy of Orthobond Corporation.)
FIGURE 12
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Before (top) and after (bottom) T2-weighted MRI images of one of our patients treated with intradiscal LR-PRP which showed near complete resolution of a chronic tear and disc protrusion within three moths. The patient is a professional golfer who had been unable to play his sport and was able to successfully return to the full golfing activities.
FIGURE 13
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This graph represents the effect of a leukocyte poor vs. leukocyte-rich PRP on the growth of bacteria (C. Acnes) in culture over time. Our study showed a greater suppression of bacterial growth with a leukocyte-rich PRP.
FIGURE 14
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Before (left) and after (right) T2-weighted MRI images of Stacey’s lumbar spine treated with intradiscal LR-PRP which showed near complete resolution of the Modic 1 changes (bright signal in the bone represented by the arrows which resolved).
FIGURE 15
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Anthony’s intradiscal procedure using a curved catheter (top fluoroscopic images) to place the LR-PRP as close to the disc tear as possible. We followed his recovery with monthly MRIs which showed healing of the annular tear (circle) over a three-month period.