Marc Darrow MD,JD

Many people have successful spinal surgery. Some do not. There are many reasons why someone will have a failed spinal surgery. One reason among the many causes can be the muscle damage caused by the fusion surgery itself.

In a situation like this we would examine the spine and look for tenderness and weakness in the muscle attachments / tendons and the spinal ligaments. If these structures are damaged, we would treat with regenerative injections including platelet rich plasma therapy and/or stem cell therapy. Read More

Marc Darrow MD,JD

As with other joint problems, I will often get emails that are simply an MRI report. The MRI tells me that the person has a disc herniation at L1 or L2 or L4 or L5. Then the report will describe varying degrees of degenerative disc disease. The email will end with “can you help?” That answer would be easier if there was some more information included in that email.

At no point in the email did the person say how bad their pain was, what type of limitations they had, or how their back problem was affecting their ability to work or be active. Information as simple as knowing how someone’s back feels today is good information to have when trying to determine if our treatments can help.

It is not the emailers fault for excluding this information. For some people, they have been trained that the MRI has captured the image of what is causing their pain and this image can be used as a roadmap or baseline to help doctors plot out a surgical path now or in the near future. I get the MRI report because these people are exploring ways to avoid that surgery.

Research: some surgeries and MRIs are “unjustified and wasteful healthcare expenditures.”

The problem of over reliance on MRI is that they can send you to a surgery you may not need. A study that appeared in the medical journal Radiologia (Radiology) (1) examined the traditional recommendations of sending a patient to get an MRI and then offering a surgery based on what the MRI indicated. The researchers had concerns about the enthusiasm some surgeons had for surgery that was likely inappropriate.
Read More

Marc Darrow MD,JD

This is a Darrow Stem Cell Institute research article published in the Biomedical Journal of Scientific & Technical Research (BJSTR), July 2018. This article presents highlighted portions of that research. For the full article please visit this link.
Read More

Marc Darrow MD,JD

As with other joint problems, I will often get emails that are simply an MRI report. The MRI tells me that the person has a disc herniation at L1 or L2 or L4 or L5. Then the report will describe varying degrees of degenerative disc disease. The email will end with “can you help?” That answer would be easier if there was some more information included in that email.

At no point in the email did the person say how bad their pain was, what type of limitations they had, or how their back problem was affecting their ability to work or be active. Information as simple as knowing how someone’s back feels today is good information to have when trying to determine if our treatments can help.

It is not the emailers fault for excluding this information. For some people, they have been trained that the MRI has captured the image of what is causing their pain and this image can be used as a roadmap or baseline to help doctors plot out a surgical path now or in the near future. I get the MRI report because these people are exploring ways to avoid that surgery.
Read More

Marc Darrow MD,JD

I want to begin this article with two case studies we recently published research in the Biomedical Journal of Scientific & Technical Research.(1)

• The patient was a 77 year-old female with a 20-year history of lower back pain, which had progressed with age.
• The patient wore a back brace to attempt to reduce the stiffness and pain when standing or sitting for extended periods of time.
• Radiographic assessment of her lumbar spine showed mild dextroscoliosis (a sideways curve) and
• a mild narrowing of L1-L2, L3-L4 and moderately severe narrowing of L5-S1.
• Her baseline resting and active pain prior to treatment was:
  • 1/10 (resting) and 5/10 (active), and a 33/40 functionality score.

After physical assessment of her lower back, we determined her pain was generated from a lumbosacral sprain. Not the narrowing of the L1-L5,S1

Read More

In many patients that come into our office, there is a complexity of symptoms and pain in multiple joints. In one patient, for instance, it could be back pain, hip pain, and knee pain. In the patient history, we ask that patient if they have been recommended to any surgeries? Sometimes they will respond, “yes, I have been recommended to back surgery,” or sometimes they will say, “my spinal surgeon is suggesting back surgery, my orthopedist is recommending hip surgery. The two of them agree that I should have the hip surgery first then the spinal surgery.” Sometimes a patient will say that their doctors are recommending a spinal surgery, hip surgery, and bi-lateral knee replacement, which surgeries first are dependant on which is thought to be the worst of their problems.

In this article I will discuss research that suggests that in some of these situations, where a patient has hip, back and knee pain, the rush to surgery may be sending many patients to an inappropriate or unnecessary surgery knee replacement.

Knee pain complaints in women over 50. Is it really knee osteoarthritis or is it hip pain? Back pain? Weight?

Here is an interesting 2018 study (2) centered on women over the age of 50.

The researchers of this study investigated the factors associated with the level of knee pain in community-dwelling women aged 50 years or older. The radiographic grade of knee osteoarthritis, presence of low back pain, level of hip pain, Body Mass Index and presence of depressive symptoms were significant factors associated with the level of knee pain in the study group. For women without knee osteoarthritis, knee pain was found to increase according to increasing age, BMI, level of hip pain, and presence of low back pain. For women with knee osteoarthritis, knee pain was significantly associated with radiographic grade of knee osteoarthritis, BMI, level of hip pain, presence of low back pain, and presence of depressive symptoms.

Previous studies have indicated that patients with hip disease can go to the doctor with with knee pain. The sensory nerves of both the hip and knee joints originate from the femoral, sciatic, and obturator nerves (nerves at the L2-L4 lumbar region that impacts the mid-thigh). Hip joint pathology is known to be an important cause of pain referred to the knee joint. In addition, spinal problems can cause anterior knee pain through radiating pain or through the weakness of the quadriceps muscle. A previous study showed a high percentage of spinal symptoms in patients with knee pain, compared with controls. Although hip or back pain does not necessarily represent hip pathology or radiculopathy, our study results suggest that associated hip and spine disorders need to be evaluated in women with knee pain.

The question is. Women with knee pain without MRI evidence of osteoarthritis and women with knee pain with clear evidence of osteoarthritis. In this study the doctors warned to check the back, the hip, depressive episodes, and weight to determine the true cause of pain. This could prevent a recommendation to surgery that was not needed, worse, the wrong joint gets operated on.

Having the wrong joint replaced is not a new problem, it happens quite often, especially when the hip is involved.

In a study published in the medical journal Modern Rheumatology,(3) surgeons discussed the complexity of hip disease and how it impacts other joints and areas of the body.

Here the surgeons found that:

• Hip disease was the cause of knee pain in 29% of patients.
• Hip disease was the cause of low back pain in 17% of patients.

Their warning to their fellow surgeons?

• “be aware of hip disease masquerading as knee pain or low back pain” That is how wrong surgeries may be performed.

“Patients may still be undergoing knee arthroplasty for degenerative lumbar spine and hip osteoarthritis.”

Here is study from surgeons in the United Kingdom. Published in the medical journal International Orthopaedics, (4) the surgical team of this study wanted to answer the question as to why up to 20% of total knee replacement patients complain of persisting pain after the knee replacement. Here was there answer:

• The investigators examined 45 consecutive patients with pain after total knee replacement. Of the 45 patients, one-third, 15 patients had degenerative hip and lumbar spine disease. Nine patients had unexplained pain.
• The study concluded: “Patients may still be undergoing knee arthroplasty for degenerative lumbar spine and hip osteoarthritis. We suggest heightened awareness at pre- and post-operative assessment and thorough history and examination with the use of diagnostic injections to identify the cause of pain if there is doubt.”

The patients still had knee pain after knee replacement because it was not their knee generating the knee pain, it was the hip and spine.

A 2017 study published in the journal Clinical Orthopedic Surgery, (4) doctors found that in the patients they examined with pain after knee replacement

• 25.6% of the patients in the study were found to have nerve entrapment in the spine,
• 15.4% were found to have hip osteoarthritis or femoral head avascular necrosis.

Knee pain persisted after knee replacement because the problem was not the knee but the hip and spine.

Physical examination can help rule out “wrong joint surgery”

I have written extensively on this website about the problems of MRIs sending people to surgery that they do not need. W\hat an MRI cannot do is gently press on the hip joint. If we can press on the hip joint and you get a shooting pain in your knee, we can have a realistic expectation that knee replacement may not be the answer. If we can gently press on your spine, and this creates a knee pain, we may come to the same conclusion. Knee replacement may not be the answer.

Do you have questions? Ask Dr. Darrow

A leading provider of stem cell therapy, platelet rich plasma and prolotherapy
11645 WILSHIRE BOULEVARD SUITE 120, LOS ANGELES, CA 90025

PHONE: (800) 300-9300 or 310-231-7000

Stem cell and PRP injections for musculoskeletal conditions are not FDA approved. We do not treat disease. We do not offer IV treatments. There are no guarantees that this treatment will help you. Prior to our treatment, seek advice from your medical physician.

Neither Dr. Darrow, nor any associate, offer medical advice from this transmission. This information is offered for educational purposes only. The transmission of this information does not create a physician-patient relationship between you and Dr. Darrow or any associate. We do not guarantee the accuracy, completeness, usefulness or adequacy of any resource, information, product, or process available from this transmission. We cannot be responsible for the receipt of your email since spam filters and servers often block their receipt. If you have a medical issue, please call our office. If you have a medical emergency, please call 911.

REFERENCES:
1. Dibra FF, Prieto HA, Gray CF, Parvataneni HK. Don’t forget the hip! Hip arthritis masquerading as knee pain. Arthroplasty today. 2018 Mar 1;4(1):118-24.
2 Lee KM, Kang SB, Chung CY, Park MS, Kang DW, Chang CB. Factors associated with knee pain in 5148 women aged 50 years and older: A population-based study. PLoS One. 2018 Mar 8;13(3):e0192478. doi: 10.1371/journal.pone.0192478. PMID: 29518078; PMCID: PMC5843201.
3 Nakamura J, Oinuma K, Ohtori S, Watanabe A, Shigemura T, Sasho T, Saito M, Suzuki M, Takahashi K, Kishida S. Distribution of hip pain in osteoarthritis patients secondary to developmental dysplasia of the hip. Modern rheumatology. 2013 Jan 1;23(1):119-24.
4. Al-Hadithy N, Rozati H, Sewell MD, Dodds AL, Brooks P, Chatoo M. Causes of a painful total knee arthroplasty. Are patients still receiving total knee arthroplasty for extrinsic pathologies? Int Orthop. 2012 Jan 11.
5. Lim, H.-A., Song, E.-K., Seon, J.-K., Park, K.-S., Shin, Y.-J., & Yang, H.-Y. (2017). Causes of Aseptic Persistent Pain after Total Knee Arthroplasty. Clinics in Orthopedic Surgery, 9(1), 50–56. http://doi.org/10.4055/cios.2017.9.1.50 — 1494

Marc Darrow MD,JD

When we see a patient in our office who has joint or back pain and they have clear issues of excessive weight, we try to reassure the patient that we understand that it can be difficult to lose weight. We tell them that we are not going to lecture them and that we will try to present solutions that are realistic.

There has been a large amount of published research, recently released, that suggests that it is not only the mechanical stress that a big belly puts on your lower spine that can cause back pain, but the runaway inflammation that the belly fat is producing that may be attacking your spinal nerves.

Research: Overweight people have more neuropathic back pain, tingling sensations, severe back pain, and acute back pain compared to normal weight people with back pain.

A 2016 study published in the journal Pain research and management (1) made these suggestions:

• Obesity could be the cause of neuropathic (nerve) pain that is distinct from musculoskeletal pain. Neuropathic may not have an obvious source, such as the degenerative damage seen in disc disease. This pain may be originating from the inflammation the body fat of the obese people is producing.
  • Study Finding: Results showed that the overweight patients with neuropathic pain complained of more severe pain than the normal-weight patients in spite of comparable analgesic dosages (i.e., on a proportional body-weight basis).
  • In addition, the overweight patients seemed to experience more serious paroxysmal (sudden acute attacks of pain or spasm) pain, and their neuropathic negative symptoms (for example an increase in tingling or numbness) might tend to be aggravated. (It can be suggested that patients who suffer from spasms, acute pain, numbness and tingling sensations, have these symptoms caused not by a pinched nerve, but by the inflammation being generated by their abdominal fat.)

The researchers of this study then made this point: Read More