regenerative treatment of spinal conditions · varun singla, etal. 40 patients with chronic low...

Regenerative Treatment of Spinal Conditions

Gerard A. Malanga, MDKessler Institute Regenerative MedicineNew Jersey Sports Medicine, LLCNew Jersey Regenerative InstituteClinical Professor, Department of PM&RRutgers School of Medicine

Diclosures

Editor, textbook: Musculoskeletal Physical Examination: An Evidence-Based Approach

Atlas of Ultrasound-Guided Musculoskeletal Injections; Regenerative Treatments in Sports and Orthopedic Medicine

Consultant: Lipogems PRP and Stem cell therapies are provided in my

practice.

Disclosures:Graduate of Villanova University Incoming President/Board

Interventional Orthopedic Foundation

11/27/2018 3

Disclosures

Lipogems Consultant

Outline

Discuss Cells and Sources Processing Pathology

Ligaments/Muscles Sacroiliac Joint Facet Radiculopathy Disc

Platelet Rich Plasma (PRP)and Lysate PRP (PLRA)

Number of Platelets Leukocyte content RBC content Activation

Lysate Temperature Mechanical Chemical

A Call for a Standard Classification System for Future Biologic Research: The Rationale for New PRP Nomenclature. Mautner et al. PMR 2015

Mesenchymal Stem Cells

Commonly found in:• Bone Marrow• Adipose Fat Cells• Circulating Blood (few)• In Joints (very few) • Capillaries (Pericytes)

Stem Cell Sources

Historically, Bone Marrow stem cells have been felt to be the optimal source of stem cells for Orthopedic conditions

There is recent evidence that it may not make a difference with more studies support the use of Adipose-derived stem cells for a variety of orthopedic conditions

Adipose tissue requires some level of processing to extract the ADSC that is often beyond FDA restriction of ‘Minimal Manipulation”

Bone Marrow Aspiration

Where Obtained How Obtained Processing

RBCs

Technical Issues in Harvesting and Concentrating Stem Cells (Bone Marrow and Adipose). Bowen J. PMR 2015

• Bone marrow was aspirated from 20 patients during total knee arthroplasty

• Iliac Crest• Metaphysis of the Distal Femur• Proximal Tibia

• MSCs were isolated, cultivated and characterized by their immunophenotype and by their in vitro potential for differentiation into osteoblasts, chondroblasts and adipocytes• MNC Concentration was significantly higher in the Iliac Crest (10.05 Millions/ml) compared with the femur (0.67 Millions/ml) and tibia (1.7 Millions/ml).• Trilineage differentiation was achieved with all samples

BMA v. Adipose

ADSC High Number of Cells/unit of Tissue Volume

Generally 5-50x more in Adipose v. BM

More Rapidly Proliferate in Culture Less Susceptible to Senescence in Culture Expansion

New System for Harvesting Adipose

Closed-loop device for Autologousadipose tissue

No centrifuge required Progressively micro-fractures adipose

tissue clusters and minimizes inflammatory oily and blood residue

Minimally Manipulated (no enzymatic digestion)

Is there ANY Evidence It Works ?????

Spinal Conditions

Muscles/Ligaments SIJ Facet Radiculopathy Degenerative Disease Disc Post-Laminectomy

Chronic Low Back Pain -Lumbar Muscle AtrophyEffect of autologous platelet leukocyte rich plasma injections on atrophied lumbar multifidus muscle in low back pain patients with monosegmental degenerative disc disease. Hussein, 2016

104/115 Patient with Chronic Non-Specific LBP Tx: Weekly PLRP x 6. F-U 2 years Outcomes

Numeric Pain Scale and Oswestry Disability Index Patient Satisfaction, modified MacNab, Lumbar MRI

PLRP - Lumbar Muscles

Results No Serious Complications NPS: 8.8 to 3.45 (1 year) ODI: 73.5% to 29.3% (1 year) Outcomes remained stable from 18-24 months 87.8% Decreased Fatty Multifidus Changes of 1 year MRI Patient Satisfaction 71.2% Mod. MacNab (18 months)

60.2% Excellent and 17.3% Good = 77.5%

Sacroiliac Joint

About 20% of Low Back Pain

Sacroiliac JointA randomized controlled trial of intra-articular prolotherapy versus steroid injection for sacroiliac joint pain. Kim WM. etal. 2010

Prolotherapy 23 Prolotherapy Treated Patients 25 Steroid Treated Patients 15 month Follow up

Pain Relief and Disability Scores 58.7% Prolotherapy and 10.2% Steroid Improved

Case series of Ultrasound-guided Platelet-Rich Plasma Injections for Sacroiliac Joint Dysfunction. Ko G. 2017

4 Patients Outcomes: Short McGill Pain Questionnaire, NPS,

Oswestry Low Back Pain and Disability Index at 0, 12, 48 months

Follow up: Statistical Improvement in Stability, Pain Reduction, and Increase QOL at Maintained at 4 years

Steroid vs. Platelet-Rich Plasma in Ultrasound-Guided Sacroiliac Joint Injection for Chronic Low Back PainVarun Singla, etal.

40 patients with chronic low back pain diagnosed with SIJ pathology were randomly allocated into 2 groups

Group S received 1.5 mL of methylprednisolone (40 mg/mL) and 1.5 mL of 2% lidocaine with 0.5 mL of saline, while into ultrasound-guided SIJ injection. Group P received 3 mL of leukocyte-free PRP with 0.5 mL of calcium chloride

Intensity of pain was significantly lower in Group P at 6 weeks 1 [1 to 1] vs. 3.5 [2 to 5]; P = 0.0004) and 3 months (Median [IQR] = 1 [1 to 3] vs. 5 [3 to 5]; P = 0.0002) as compared to Group S

MODQ and SF-12 scores were improved initially for up to 4 weeks but deteriorated further at 3 months in Group S, while both the scores improved gradually for up to 3 months in Group P

**The efficacy of steroid injection was reduced to only 25% at 3 months in Group S, while it was 90% in Group P

Facet Mediated Pain

Using Intra-articular Inject Facet Joint and PRPA New Technique for the Treatment of Lumbar Facet Joint Syndrome ion with Autologous Platelet Rich Plasma. Wu. et al. Pain Physician 2016

19 Lumbar Facet Syndrome (8 men, 11 women)

Good/Excellent Outcomes Immediate 47% 1 week 74% 1 month 79% 2 months 79% 3 months 79%

A Prospective Study Comparing Platelet-Rich Plasma and LA/Corticosteroid in Intra-Articular Injection for the Treatment of Lumbar Facet Joint SyndromeJiuping Wu, Jingjing Zhou, et al. 2016

46 eligible patients with lumbar facet joint syndrome were randomized into group A (intra-articular injection with PRP) and group B (intra-articular injection with LA/corticosteroid)

Pain visual analog scale (VAS) at rest and during flexion, and the Roland-Morris Disability Questionnaire (RMQ), Oswestry Disability Index (ODI), and modified MacNab criteria for pain relief and applications of post-treatment drugs

All outcome assessments were performed immediately after and at 1 week, 1 month, 2 months, 3 months, and 6 months after treatment

A Prospective Study Comparing Platelet-Rich Plasma and LA/Corticosteroid in Intra-Articular Injection for the Treatment of Lumbar Facet Joint SyndromeJiuping Wu, et al

There were No Treatment-related Complications in either group during follow-up

Both Groups demonstrated statistical improvements in the pain VAS score at rest or during flexion, the RMQ, and the ODI (P < 0.01) There were significant differences between the 2 groups on

the above-mentioned items (P < 0.05).

A Prospective Study Comparing Platelet-Rich Plasma and LA/Corticosteroid in Intra-Articular Injection for the Treatment of Lumbar Facet Joint SyndromeJiuping Wu, et al

Group A (PRP)1 month MacNab criteria (excellent+good):

61.9% Objective success: 61.9%

6 months MacNab criteria (excellent+good):

81% Objective success: 81%

Group B (Steroid)

1 month MacNab criteria (excellent+good):


6 months MacNab criteria (excellent+good):


A Prospective Study Comparing Platelet-Rich Plasma and LA/Corticosteroid in Intra-Articular Injection for the Treatment of Lumbar Facet Joint Syndrome

Roland-Morris Oswestry Disability Index

Regenerative Treatments for Radiculopathy

Injecting Platelet Lysate Instead of Steroid Medications

Avoid Steroid side effects Possibly Regenerative

Cortisone vs PRP Epidural

Registry data on PL Epidurals

This is data from a prospective, multi-site U.S. registry data, 2015

0

1

2

3

4

5

6

Preop - Average pain 3 month - Average pain 6 month - Average pain

Average Pain

ESI

PL/Dex

ESI vs. PL Epidurals

n Preop n 3 month n 6 month

ESI 79 5.42 31 4.77 23 4.78

PL/Dex 139 4.28 73 3.37 53 3.47

Chart1

Preop - Average painPreop - Average pain

3 month - Average pain3 month - Average pain

6 month - Average pain6 month - Average pain

ESI

PL/Dex

Average Pain

5.417721519

4.2805755396

4.7741935484

3.3698630137

4.7826086957

3.4716981132

Patient List

Patient NameDate of InjectionPrior ESI?Epidural typeEpidural locationGenderAGENumber of InjectionsTime from 1st to 2nd Inj or Cross over2nd Inj or Cross-over Date3rd Inj Date4th Inj Date

Acosta, Mo9/20/12NoESIL5-SIM3210

Adkins Sarah3/1/12NoPL/DexBILATERAL L1-L2 & S1 TF ESI WITH PL/DEX ADD PROLOTHERAPY T12-S1, BILATERAL SI JOINT INJECTIONF384213/22/125/10/125/31/12

Ahmann, Theresa8/30/12NoPL/DexL3-L4-L5 L5-SIF4610

Aiello Tyler12/22/11YesPL/DexBILATERAL L5-S1, S1 TF ESI PL/DEXM3610

Alger Sharon6/1/12NoPL/DexLUMBAR TF ESI c PL/DexF4910

Anand Sheel G.12/2/11NoPL/DexLUMBAR TF ESI c PL/DexM4010

Anderson Specher Chris1/26/12NoPL/DexRIGHT S1 TF ESI / CAUDAL WITH PL/DEX-ADD BILATERAL SI PROLOM5510

Anderson, Stephen10/11/12NoESIL3-L5 BilateralM6110

Andrews Denise4/19/12NoESIBilateral C4-5F4610

Andriuska Viktoras12/15/11NoPL/DexLUMBAR TF ESI c PL/DexM4010

Anson Byron1/5/12YesESIRIGHT SI JOINT INJ ADD RIGHT S1 TF ESIM5410

Antis Jeremy5/31/12NoESIBILATERAL C5-C6 TF ESIM3510

Archer John4/5/12NoESIBILATERAL L4-L5, L5-S1 TF ESIADD BILATERAL L4/S1 IAFM6810

Arena John12/15/11NoESIBIL. L3-L4,L4-S1 TF ESIM4810

Babb Shirley5/10/12NoPL/DexBILAT KNEES - B L5-S1 TF ESI c PL/Dex & T11-12F702366/15/12

Bain Kristen5/10/12NoESIBILATERAL S1 TF ESI BILATERAL SI JOINTF3710

Barbouti Loretta12/8/11YesPL/DexBIL SI TF ESI c PL/Dex, R SI JOINTF7210

Basile, Anthony8/23/12NoPL/DexL4- L5 L5-SIM4210

BASILE,ANTHONY J9/27/12NoESIL2-3 L4 -TfM4210

Bazos George12/7/11NoPL/DexLUMBAR TF ESI c PL/DexM3910

Beavers David A.6/14/12NoESIBILATERAL L5-S1, S1 TF ESIM542989/20/12

Beberniss Deb5/17/12NoPL/DexL5-SI BilateralF4610

Behnke, Nicole8/15/12NoPL/DexL4-L5 SIM1810

Bell James5/11/12NoPL/DexLEFT FEMORAL NERVE INJECTION WITH PL/DEXM502567/6/12

Bernatis David3/8/12NoESIBILATERAL T12-L1 TF ESIM152354/12/12

Bickerton Larry5/9/12NoPL/DexBILATERAL L5/S1 TF ESI C PL/DEXM6110

Bishop Freda4/4/12NoESIRIGHT C7-T1, T1-T2 TF ESIF4710

Bossert Glenn5/15/12NoPL/DexLUMBAR TF ESI C PL/DEX - L5/S1, S1M5710

Brewer, Diana8/16/12NoESIC5-C6-C7M6210

Brooks, Josiah8/22/12NoPL/DexT5-T7M2710

Brown Charles V. Jr6/13/12NoESILEFT L5-S1,S1 TF ESIM6810

Brown John4/12/12NoESILEFT C4-C6 TF ESIM572144/26/12

Brown Patricia6/14/12NoESIRIGHT C4/5, C5/6 TF ESIF4010

Busatti Robert1/19/12NoPL/DexBIL. S1 TF ESI- WITH PL/DEXM573142/2/122/23/12

Butler Angelina2/23/12NoESIbil. l5-s1 s1 tf esi add bil si jointsF8210

Campbell Vera Anne1/13/12NoPL/DexLUMBAR TF ESI c PL/DexF6210

Cargas, Jack6/28/12NoPL/DexM5210

Charalambous Yvonne12/7/11NoPL/DexRGXX-PLDisc - BILAT L2-L5 TF ESI c PL/DexM7310

Chyc Wei-Kheng10/20/11NoESIBILATERAL L5-S1, S1 TF ESIF5122376/13/12

Clark, Cobiana9/5/12NoPL/DexC5-C6F442219/26/12

Cole Cheryl A.7/7/11NoESIRIGHT C5-C6, C6-C7 TF ESIF5410

College, Michael8/9/12NoPL/DexSI Bilaterlal PL/DEXM7510

Collins Judith Ann3/7/12NoPL/DexLeft L3-L5 TF ESI with PL/DexF593284/4/126/21/12

Colman Craig3/27/12NoPL/DexL SPINE/C SPINE - PL/DexM6410

Conn Gary6/7/12NoPL/DexBILATERAL C5-C6, C6-C7 TF ESI WITH PL/DEXM6810

Conn Vera6/8/12NoPL/DexLUMBAR TF ESI c PL/DexF6410

Conners Pam5/3/12NoESIBILATERAL L5-S1, S1 TF ESIF4810

Cornejo, Everado3/21/12NoESIBILATERAL S1 TF ESI/ CAUDALM3910

Corsentino, Barbara7/6/12NoPL/DexF6710

Curtis, Jimmy6/28/12NoESIM3910

Darrah Michael M.3/8/12NoPL/DexBIL S1 TF ESI c PL/DexM5210

Davis John1/6/12NoESIBILATERAL L5-S1, S1 TF ESIM4921787/2/12

Dawes Paxton5/30/12NoESIBILATERAL L4-L5 SNRBBCBS- NO SEDATION.M4310

Dawkins, Pebbie "Trey"8/20/12NoESIL3-L4 L4-L5M4010

Day Alec10/26/11NoPL/DexBILAT RIBS- ANTERIOR- PL/DEX X2M3532311/18/1112/14/11

Deal Rae1/19/12NoESIBILATERAL L5-S1, S1 TF ESIF4810

Decker Clinton12/22/11NoESIBIL L4-L5,L5-S1 TF ESIM344281/19/122/2/122/16/12

Decker, Otto8/22/12NoPL/DexL5-SI SI - TFM6010

Dee Timlin Delores5/10/12NoPL/DexBIL S1 TF c PL/DexF7010

Dickstein, Simone7/12/12NoPL/DexL3-L4 + SIF5510

Dirico Frank1/12/12NoPL/DexBILATERAL C3/C4, C4/C5 TF ESI PL/DEXM4710

Domalpalli Rajnesh6/12/12NoPL/DexL4-L5, L5-S1 TF ESI & FACET INJECTIONS c PL/DexM502297/11/12

Dooley Gwen1/11/12YesPL/DexBILATERAL L4-5, L5-S1 AND ACL/MCL POST- SAME DAY WITH PL/DEXF7210

Dr. Austin, Gordon8/14/12NoPL/DexL4-L5M6010

Dr. Mccallen, Julie8/17/12NoPL/DexL5 SIF4910

Drucker, Janet8/30/12NoESIL2-L5F5510

Dubois, Cindy7/26/12NoESISI BilateralF2710

Dunne Karen4/24/12NoPL/DexLeft L3-L4 TF ESI PL/DEXF4410

Dunnigan Alexa5/26/11NoPL/DexBIL L5-S1, S1 TF ESI c PL/DexF2210

Dye Sheryl1/24/12NoPL/DexBIL S1 TF ESI c PL/Dex.F5510

Edelman Nichole12/8/11NoPL/DexRIGHT L4-L5,L5-S1 (COUNT 1/2 HEIGHT DISC @L5-S1) PL/DEX TF ESIF1731412/22/111/5/12

Egnatovich Robert9/8/11YesPL/DexBIL L5-S1, S1 + L1-L2 TF ESI c PL/DexM4310

Elder Stacy5/8/12NoESILEFT C5-C6, C6-C7 TF ESI NOF451496/26/12

Elder Stacy6/26/12YesPL/DexLEFT C6-C7 TF ESI WITH PL/DEXF452448/9/12

Elrefai Alaa5/22/12NoPL/DexBIL L4-L5, L5-S1 TF ESI c PL/DexM5610

Enlow Linda6/2/12YesPL/DexL4-S1 ESI pl dexF5910

Erbe Kevin4/10/12NoPL/DexPL/DEX: BILATERAL S1, BILATERAL SS/IS WITH PL/DEXM4910

Espinoza Fabian1/19/12NoESIBILATERAL L3-L4, L4-L5 TF ESIM4710

Esquibel, Linda7/26/12NoPL/DexL4-SI SI LeftF5610

Esses Melissa5/11/12NoESIBILATERAL L5-S1, S1 TF ESIF4310

Evans, Amanda9/6/12NoPL/DexL5-SI SI - TFF2623510/11/12

Farmer Chad E3/21/12NoESIRIGHT L3-L4, L4-L5 TF ESIM3910

Farmer Chad E4/12/12YesPL/DexBILATERAL L5-S1, S1 TF ESI WITH PLM392225/4/12

Fenwick Steven3/6/12NoPL/DexPL/DISC; BILATERAL L2-L5M5310

Fereidooni Alireza5/24/12NoPL/DexL5-SI RightM352778/9/12

Ferris Clinton5/24/12NoPL/DexL4-SI,SI BilateralM7810

Figler Sharon5/2/12NoESIBILATERAL S1 PL ESIF5310

Finger, Heidi8/16/12NoESIC3,C4,C5F472359/20/12

Fitzgerald Theresa5/3/12NoPL/DexBILATERAL L4-S1, S1 TF ESI WITH PL/DEXF5410

Fitzgerald Timothy10/26/11NoPL/DexLumbar TF pldexM4221323/6/12

Flessner Nathan5/8/12YesPL/DexLEFT L3-L4LEFT L5-S1, S1 TF ESI WITH PL/DEX X3, Q 3M192386/15/12

Flessner, Stepher9/6/12NoESIL5-SIM5810

Foley Frank1/12/12NoPL/DexAD L KNEE - BIL L5-S1, S1 TF ESI c PL/DexM6010

Franz Stephanie1/26/12NoPL/DexBILATERAL L2-L3, L3-L4, L4-L5, S1 TF ESI PL/DEXF5210

Frasor Theresa5/10/12NoPL/DexRIGHT SI TF ESI, RIGHT SI JOINT INJECTION ADD PL/DEXF5710

Frederick Elizabeth12/13/11YesPL/DexLUMBAR TF ESI c PL/DexF7010

Fry, Charles6/28/12NoPL/DexBILATERAL L3/L4; L4/L5; L5/S1 TF PL/DEXM422498/16/12

Garduno Robert12/15/11NoESIBILATERAL T7-T8, BILATERAL T11-12 TF ESIM2710

Garrett Shauna1/26/12NoESIBILATERAL L5-S1, S1 TF ESI ADD SI JOINT INJECTIONF3431055/10/1210/4/12

George, Kathleen6/27/12NoESIF5510

Gerson Chartles DR. PHD4/20/12NoPL/DexUMBAR TF ESI c PL/DexM7710

Gibson, Jennifer9/20/12NoESIC7 - T1F4510

Gilbreath, Vance M.9/11/12NoPL/DexC5-C7 L3-L5M5510

Girten Susan1/26/12NoESIBILATERAL L5-S1, S1 TF ESF5210

Gisle , Gary7/31/12NoPL/DexLumbar TFM7310

Glasser Joan6/9/11NoPL/DexBILATERAL CERVICAL ESI c PL/Dex,F6410

Gonzales Maria M10/20/11NoPL/DexBILATERAL L4-L5, L5-S1, S1 TF PL/DEX ESIF4422111/10/11

Good David1/26/12NoPL/DexBILATERAL SI TF ESI WITH PL/DEXM4810

Grabowski, Robert8/17/12NoESIL5-SIM7110

Greenstreet Greg12/15/11NoESIT7-8 TF ESIM4410

Guerrero, Ana Marganita7/24/12NoESIF4710

Guillory Delery3/19/12NoPL/DexLUMBAR TF ESI c PL/DexM5610

Gunn Jessie M.6/12/12NoESIBILATERAL S1 TF ESI WITH PL-MF9610

Hagaman Kari1/9/12NoESILEFT C5/C6, C6/7 TF ESIF4710

Hagedorn James3/28/12NoPL/DexLUMBAR TF ESI C PL/DEX - L4-L5, L5-S1M6110

Hannett, Joanne8/1/12NoPL/DexLumbar TFF6210

Harbert, Steven9/20/12NoESIL4-L5 -SIM6210

Hardacre Richard3/19/12NoPL/DexBILATERAL C4-C5, C5-C6 PL/DEXM6210

Harding Gregg2/9/12NoPL/DexRIGHT C5-C7 TF ESI WITH PL/DEXM4410

Harris James12/8/11YesPL/DexLEFT L4/5, L5/S1, S1 TF PL/DEXM3210

Hartley Scott5/7/12NoESIBILATERAL S1 TF ESIM4810

HAVENGAR,CURTIS G9/20/12NoESIL5-SI SI - TFM2810

Hawron Denise4/3/12NoPL/DexLUMBAR DISC PATIENT - LUMBAR TF ESI c PL/DexF4810

Hazen Louis3/13/12NoPL/DexBILATERAL L4-L5, L5-S1 TF PL/DEXM4610

Heiser Michael5/26/11YesPL/DexBIL L4-L5, L5-S1 TF ESI c PL/Dex.M5810

Herr, Judith9/6/12NoESIC5-C6-C7F4610

Hestera David12/23/11YesPL/DexBIL L5-S1, S1 TF ESI c PL/DexM5022177/27/12

Hickman Jeff12/28/11NoESIbilateral l4-l5, l5-s1ESIM3810

Hill Carolyn5/14/12NoESIRIGHT L3/L4 TF ESIF4910

Hodd Deborah5/10/12NoESIBILATERAL SIBILATERAL L5-S1, S1 TF ESIF6410

Hohenstein, Louis8/17/12NoPL/DexLumbarM4510

Holaway Michele D.6/19/12YesPL/DexBILATERAL L5-S1, S1 TF PL/DEXF522438/1/12

Holmes Terry L.3/22/12NoESIBILATERAL L5-S1, S1 TF ESIF5710

Hubchik Josephine6/7/12NoPL/DexRIGHT L4-S1, S1 TF ESI WITH PL/DEXF5710

Hughes Brian2/23/10NoESIL3-SI SI BilateralM5510

Hussuen, Omar A.6/28/12NoPL/DexL4-SIM293428/9/128/30/12

Jent Darrell Jr.3/22/12NoPL/DexBILATERAL L1-L2 & S1 TF ESI WITH PL/DEX ADDM445495/10/125/24/126/7/1210/4/12

KACHADURIAN,PETER10/3/12NoPL/DexL2-3-M3010

Katz, Seana9/13/12NoPL/DexSI jointF4410

Keany Karen11/17/11YesESIBILATERAL L5-S1, S1 TF ESIF5112812/15/11

Keany Karen12/15/11YesPL/DexBIL L5-S1, S1 TF ESI c PL/Dex.F513281/12/122/16/12

Kearney, Kathleen9/12/12NoPL/DexL5 TFF7810

Kachele William5/8/12NoPL/DexLUMBAR PL/Dex - LUMBAR TF ESI c PL/DexM5310

Keel Jennifer1/12/12YesESIBILATERAL C5-C6 TF ESIF371422/23/12

Keel Jennifer2/23/12YesPL/DexC5-C6 bilateral PL/DEXF372775/10/12

Kelley Ronda12/8/11NoESILEFT L5-S1, S1 TF ESIF5222528/16/12

King david3/14/12NoESIWrist Plex RightM7210

Klein Woodard Julie3/16/12NoPL/DexBILATERAL L4-L5, L5-S1 PL/DEXF462485/3/12

Kreutzer, Della7/26/12NoESISI jointF7110

Kuhn Victor10/31/11NoESIBIL. L5-SI , SI TF ESI AND BIL L4-SIM3310

Laine Robert3/8/12NoPL/Dexbilateral l4-l5 iaf with over fill, bilateral s1 tf esi with pl dex.M4710

Lanning, Anne8/16/12NoESIL4-L5 L5-SIF3110

Larson Dave6/7/12NoESIBILATERAL T10-T11, L1-L2 TF ESIM4210

Larson, Craig6/26/12NoPL/DexLUMBAR TF/ESI C PL/DEX - PL BILATERAL S1M4110

Lauer Ronald1/20/12NoPL/DexLUMBAR TF ESI c PL/DexM6610

Levin, David8/9/12NoPL/DexC5-C6 C6-C7M6410

Levin, David10/11/12NoPL/DexL4-Si RightM6410

Lilly Barton4/15/11YesPL/DexPL/DEX, BILATERALL4- L5, L5-S1, S1 TF ESIM703195/4/115/25/11

Llyod Leonia6/20/12NoPL/DexLUMBAR TF ESI c PL/DexF6210

Londo Patrick6/6/12NoPL/DexLUMBAR TF ESI c PL/DexM6910

Lord Michael4/11/12NoPL/DexBILATERAL L3-S1, (NOT S1) TF ESI ADD PROLOTHERAPYADD PL/DEXM553345/15/128/7/12

Lovell Dianne6/7/12NoPL/DexRIGHT L4-S1, S1 TF ESI WITH PL/DEXF5410

Macklin Jenenne4/4/12NoPL/DexLUMBAR TF ESI c PL/DexF5710

Maestas Suzanne4/26/12NoPL/DexLEFT L5-S1, S1 TF ESI WITH PL/DEX add focus at L4-L5F71455/1/126/14/127/24/12

Major, Mary Jo7/31/12NoPL/DexBilateral TfF5610

Manna Christine5/24/12NoPL/DexR S1 TF ESI c PL/Dex,F5210

Marr Peter5/24/11NoPL/DexLUMBAR TF ESI c PL/Dex.M5610

Marsters, Buck10/10/12NoPL/DexSI BilateralM4410

Martinez Chase1/19/12NoPL/DexBILATERAL L4-L5, L5-S1 TF ESI WITH PL/DEXM503282/16/123/14/12

Martinez David1/19/12NoESIBILATERAL C6- C7 TF ESIM6410

Martinez, Robert9/6/12NoESIL4-L5 L5-SIM5310

Mason Gary4/5/12NoESIM5111258/8/12

Mason Gary8/8/12YesPL/DexBilateral L3-L4M5110

Mccarthy John6/20/12NoPL/DexM5710

Mcdaniel, Beate8/30/12NoESIL5-SIF4410

Mcfarren Jodi1/4/12NoESIC1-C3 IAF+ BIL. T10-T11 TF ESI/ BIL. T11-12 IAFF4410

Mcnaughton Jens2/16/12NoESIL5- S1 S1 bilateralM4010

Melton Shari12/20/11NoPL/Dexleft l5-s1, s1 tf esi with pl/dexF4410

Michaels Gus5/1/12NoESIBILATERAL L5-S1, S1 TF ESI NO ANEST. UNDER X-RAY NO ANESTM4110

Mickel John3/8/12NoPL/DexBILATERAL L5-S1, S1 TF PL/DEXM2610

Mitchell., Anne9/24/12NoESIL5-SI SI -TFF5410

Moler Nancy4/19/11NoPL/DexBIL L4-SI, SI TF ESI c PL/DexF55220611/11/11

Monarca, Vincent10/9/12NoESIL5-SI TF BilateralM4010

Monk Cheryl11/18/11YesPL/DexLTBD- LUMBAR ESI WITH PL/DEXF4242712/15/111/26/124/11/12

Montgomery, Jason9/18/12NoPL/DexL2-3-4- SIM3910

Montle Joline5/15/12NoPL/DexBILATERAL C7-T1 IL ESI WITH PL/DEXF6410

Mornes David6/7/12NoPL/DexLEFT L5-S1, S1 TF ESI WITH PL/DEXM4210

Morrissey Robert2/9/12YesPL/DexBILATERAL L4/L5; L5/S1 TF ESIM6210

Morrissey Robert1/12/12NoESIBILATERAL L4-L5, L5-S1 TF ESIM621282/9/12

Moser, Connie6/29/12NoPL/DexPL DISC C5/C6F6210

Mraz, Mark7/25/12NoPL/DexBilateral SIM6110

Mundt Lonnie12/1/11YesPL/DexPL/DEX LUMBARM4010

Munson Bret1/10/12NoPL/DexLUMBAR TF ESI c PL/DexM3510

MUSIL,DOROTHY9/27/12NoPL/DexL3-L5 BilateralF7710

O'Brian, Dan10/3/12NoPL/DexL4-L5 Bilateral PL/DEXM5610

Olaughlin Coleen1/23/12NoESIBILATERAL C6/7 TF ESIF5110

Olorunsola Margaret3/8/12NoESIleft s1 tf esi with pl/dexF6110

Oray Martin5/10/12NoESIBILATERAL L5-S1, S1 TF ESIM4410

Orendorff Donald5/31/12NoPL/DexRIGHT L5-S1, S1 TF PL/DEXM5410

Ornelas, Marissa7/26/12NoPL/DexL5-SI BilateralF2310

Padilla Devan12/8/11NoPL/DexBILATERAL L5-S1,S1 TF ESI WITH PL/DEXM2410

Pearce Penny2/9/12NoPL/Dexbilateral t10-11 tf esi with pl/dexF5610

Pellettera Joyce D.2/16/12NoESIL4-SI Si bilateralF6421055/31/12

Petitto John4/20/12NoPL/DexBIL L5-S1, S1 TF ESI c PL/DexM7010

Petri Charles12/22/11NoPL/DexBIL S1 TF ESI c PL/DexM461

Plienis Erin2/2/12NoPL/DexBILATERAL L5-S1, S1 TF PL/DEXF3410

Pliuskonis, Linda8/1/12NoPL/DexBilateral SIF4910

Plowman Ross T10/20/11YesPL/DexBILATERAL L5-S1, S1 TF PL/DEXM7410

Popp, Peter7/31/12NoPL/DexBilateral L5-SIM502439/12/12

Pratt, Gerald8/28/12NoPL/DexL4-L5 SIM7010

Price Paul1/5/12NoPL/Dexbil. l5/s1, s1 tf esi with pl/dex x3M6010

Price, Dawn8/16/12NoESIL5-SIF4710

Prochasta, Paul7/3/12NoPL/DexLUMBAR TF ESI c PL/DexM5610

Purcell Sandon5/1/12NoPL/DexBILATERAL L4-L5, L5-S1 TF ESIM492356/5/12

Putman Janyce1/17/12NoPL/DexBIL L5-S1, S1 TF ESI c PL/DexF4210

Quintana Nora12/15/11YesPL/DexBILATERAL L5-S1, S1 TF ESI PL/DEX 12-15-11F4010

Rabins, Laurisa9/13/12NoPL/DexL4- SIF3210

RATWAY,ROBERT J9/27/12NoESIL3-SI SI RightM5310

Rea Mary Lu5/24/12NoPL/DexL5-SI BilateralF5010

Reeves Laura2/16/12NoPL/DexBIL L4-L5, L5-S1 TF ESI c PL/DexF5110

Regan Gale1/12/12NoESIBILATERAL C6-C7 TF ESIF51227310/11/12

Reilly Barbra5/1/12NoPL/DexPL/DEX.F6121068/15/12

Reynolds, Carmen5/15/12NoPL/DexBIL. C6-7 TF ESI WITH PLF5910

Richey Jeff10/18/11NoESILEFT L4 - S1 S1 TF ESIM5910

Rini Darlene1/5/12NoPL/DexBIL L5-S1, S1 TF ESI c PL/DexF3310

Rivera Ronald R (tony)12/22/11NoESIBILATERAL L5-S1, S1 TF ESIM5921686/7/12

Roberts Donna2/2/12NoESIBILATERAL L3-L4, L4-L5 LOW DOSE TF ESIF6610

Roscoe John4/13/12NoPL/DexLUMBAR TF ESI c PL/DexM4910

Ross Michael2/14/12NoESIBILATERAL L5-S1, S1 TF ESI NOM5110

Ross, Daniel7/25/12NoPL/DexBilateral Tf SI Left L5 - SIM452439/6/12

Roti Sam11/22/11YesPL/DexBIL L5-S1, S1 TF ESI c PL/Dex 11-22-11M5310

Rozaklis, Mary10/4/12NoESIL5, Si BilateralF6510

Ryan Matthew2/8/12NoPL/DexLUMBAR TF ESI c PL/DexM5610

Salenieks Karina6/21/12NoESIL5-SI, SI BilateralF36111210/11/12

Salenieks, Karina10/11/12YesPL/DexL2-L4 SI LeftF3710

Samsel Bryan12/8/11NoPL/DexBIL L4-L5, L5-S1 TF ESI c PL/DexM413431/20/122/15/12

Sanfilippo Anthony5/23/12NoPL/DexBILAT L4-L5, L5-S1 TF ESI c PL-M/DexM433858/16/129/12/12

Sass Louis12/15/11NoESIRIGHT L4-L5, L5-S1 TF ESIM671421/26/12

Sass Louis1/26/12YesPL/DexBIL L2-L3, L3-L4, L5-S1 TF ESI c PL/DexM673212/16/123/8/12

Scarbeary Donald5/30/12NoPL/DexBILATERAL L5-S1, S1 TF PL/DEXM623156/14/126/28/12

Schafer Doreen4/2/12NoESIF5510

Schaler Richard2/21/12NoPL/DexBILAT TF ESI c PL/DexM5610

Schamel Randy3/12/12NoESIBILATERAL L5-S1, S1 TF ESI NOM5310

Scherbatskoy, Emily8/21/12NoPL/DexTf- SIF292299/19/12

Schumacher Stephen2/9/12NoESIBILATERAL L5-S1, S1 TF ESIM4810

Schwan Steven DR.5/24/12NoESIL5-SI ,SI BilateralM6110

Schwarz, Jeffery8/7/12NoPL/DexL3,L4 TfM5110

Segal , Manya8/16/12NoESIL4-L5 L5-SI RightF6710

Semple, Carol8/31/12NoESIL5-SIF4610

Sempson Judith2/16/12NoESIBILATERAL L5-S1, S1 TF ESI NO ANEST.F5710

Sethi, Ravinder7/31/12NoPL/DexLumbar TFM5510

Shaffer Tracy1/9/12NoESILEFT L5 + S1 TF ESIF5410

Sheesley Melody11/17/11YesESIbilateral l4-l5 tf esiF5110

Shelton Chris5/10/12NoESIBILATERAL L5-S1, S1 TF ESIM4210

Shockley Dennis5/8/12NoESIREPEAT ESI LUMBAR - BILATERAL L4-L5, L5-S1, S1 TFM592516/28/12

Shockley Dennis8/20/12YesPL/DexL3-L4-L5 L5-SIM5910

Silver, Diana7/10/12NoPL/DexM423288/7/129/5/12

Simone Ahuva4/19/12NoPL/DexBILATERAL C5-C6; C6-C7 IAF PL/DEXF6510

Slosser, John9/12/12NoPL/DexTFM5210

Smedley Cliff5/10/12NoPL/DexBILATERAL L4-S1, S1 TF ESI PL/DEXM5010

Smith ,Susan A9/27/12NoPL/DexF5110

Smith Aaron1/5/12YesESIBILATERAL T8-T9, L4-L5 TF ESIM361422/16/12

Smith Aaron2/16/12YesPL/Dexbilateral t8-t9 tf esi/right l5-s1, s1 tf esi with pl/dexM3622039/6/12

Smith, Mary Frances Ashura8/9/12NoESICervical TFM3910

Soldner Donna3/22/12NoPL/DexmaryF612364/27/12

Soodoo Nancey6/19/12NoPL/DexF5310

Spangler April1/26/12NoESILEFT T8-9 TF ESIF332212/16/12

Spangler April4/5/12YesPL/DexBILATERAL T8-T9 TF ESI WITH PL/DEXF3410

Sprung Thomas5/24/11NoPL/DexPL/DEX, BILATERAL L3-L4, L4-L5, L5-S1M5610

Stacy, Gus9/7/12NoESIC5-C6 C6-C7M6910

Stanulonis Mary4/12/12NoESIF5610

Steinhart,Deanna8/16/12NoESIL5-SIF452359/20/12

Steinmetz Sally5/27/11YesPL/DexBILATERAL L4-L5, L5-S1 L KNEE PL/Dex INJECTIONF7310

Stokoe Shirley4/26/12NoESIRIGHT S1 TF ESIRIGHT SI, ADD RIGHT KNEE PESF7610

Stookey Deann4/19/12NoPL/DexL4-5-SI BilateralF4810

STURGEON,REBECCA9/6/12NoPL/DexSI jointF3510

Sturm John4/11/12NoPL/DexBILATERAL S1 TF ESI WITH PL.M7510

Sullivan, Michael T9/6/12NoESIC5-C6 C6-C7M6612810/4/12

Sullivan, Michael T10/4/12YesPL/DexC5-C2 BilateralM6610

Surer Tammy2/16/12NoPL/DexCERVICAL LUMBAR PL EPIDURALSF3910

TCHOUBAN,CAROLYN L9/27/12NoESIC7-T1 RightF6510

Templar Dennis4/5/12NoESILEFT L4-L5, L5-S1 TF ESIM7610

Tilghman Paula A.12/23/11YesESIBILATERAL L3-L4, L4-L5 TF ESIF5822508/29/12

Tonazzi, Victor9/18/12NoPL/DexSI jointM7210

Trumble Timothy1/17/12NoESIRIGHT L5-S1, S1 TF ESI LOW DOSE UNDERM512242/10/12

Tullio Donna De,2/2/12NoPL/DexBILATERAL C4-C5, C5-C6 TF ESI WITH PL/DEXF5110

Turi Mark11/8/11NoPL/DexBILATERAL L5- S1 AND S1 TF ESI WITH PL/DEXM4410

Underwood Mike5/17/12NoPL/DexLUMBAR TF ESI c PL/DexM5110

Vahling Nancy10/17/11NoESIBILATERAL L5- S1 TF ESIF4010

Vanden Bom Elaine4/18/12NoPL/DexBIL L5-S1, S1 TF ESI c PL/DEX -; BILATERAL L4-L5 IAF;F4010

Vanlieshout James1/19/12NoPL/DexBILATERAL S1 TF ESI, CAUDAL WITH PL/DEX X3 ADD BILATERAL SI JOINTS, RIGHT IA AND L3-S1 SS /IS HACKETM532282/16/12

Vigil, J Ronald7/26/12NoPL/DexBilateral L5-SIM6910

Von Briese Kamm Constance3/23/12NoPL/DexBILATERAL L5-S1, S1 TF PL/DEXF5810

Vonesh, Catherine10/4/12NoPL/DexL5-SI RightF6010

Wakeham Donald5/22/12NoPL/DexBIL L4-L5, L5-S1 TF ESI c PL/DexM6410

Waldner Lars4/17/12NoPL/DexL L5-S1, S1 TF ESI c PL/DexM5310

Walker, Thomas8/21/12NoPL/DexL4-L5 L5- SIM642369/26/12

Ward Jack1/5/12YesESIBILATERAL L3/L4, L4/L5 TF ESIM6110

Warner Sandra2/23/12NoPL/DexL4-L5 Bilateral PL/DEXF5510

Warner, Christpher9/12/12NoPL/DexL5- SIM482139/25/12

Warren, Mary Annette10/11/12NoPL/DexSi- TF BilateralF5810

Watkins Richard D5/10/12NoPL/DexL4-L5, SI BilateralM613777/26/1210/18/12

Watlington TylerAnn4/5/12NoPL/Dex1. BILATERAL S1 TF ESI WITH PL/DEXF512214/26/12

Wegher Jeff5/30/12NoPL/DexBILATERAL S1 TF ESI WITH PL/DEXM3910

Wegher Jennifer5/30/12NoPL/DexBILATERAL L3-L5 TF ESI WITH PL/DEXF412848/22/12

Wekelo, Alfred9/26/12NoPL/DexTFM6410

Westbrook Ellen1/19/12NoESIBIL SI TF ESIF6322038/9/12

Wildgrube Rodrick5/26/11YesESIRIGHT C5-6, C6-7 TF ESIM5824458/13/12

Williams Nacy12/20/11YesESIbilateral l5-s1,s1 tf esiF5310

wilson Stephen5/4/11NoPL/DexPL/DEX L5-S1, S1 TF ESI.M6210

Winke, Dottie10/11/12NoPL/Dext7-t8 LeftF4910

Winseck, Kristi10/4/12NoPL/DexL3- Si SI rightF4910

Winter Ladessa6/14/12YesESILEFT L5-S1, S1 TF ESIF832427/26/12

Wonderly Mary4/6/12NoPL/DexKNEES, LUMBAR TF ESI WITH PL/DEXF6910

Wood Gary1/5/12NoPL/DexBILATERAL L5-S1, S1 TF ESI PL/DEX ; PROLO SS/IS L1-SM683141/19/122/2/12

Woods, Marilyn7/5/12NoPL/DexBILATER SIF6310

Yeoman Ellen4/20/12NoPL/DexLUMBAR TF ESI c PL/DexF5910

Youch Glenn3/27/12NoPL/DexLUMBAR TF ESI c PL/DexM6110

Zimba Kenneth12/13/11NoPL/DexRGXX PLDex - LUMBAR TF ESI c PL/DexM6410

Data

Patient NameDate of 1st InjectionPrior ESI?Epidural typeEpidural locationGenderAGENumber of InjectionsPreop - Least amount on painPreop - Worst painPreop - Average painPreop - how oftenPreop - How longPreop - FRI Score3 month - overall health since procedure?3 month - Least amount on pain3 month - Worst pain3 month - Average pain3 month - Average pain change3 month - how often3 month - How long3 month - FRI Score3 month - FRI Score Change3 month - Overall, how feel compared to prior to the procedure?3 month Percent (%) change6 month - overall health since procedure?6 month - Least amount on pain6 month - Worst pain6 month - Average pain6 month - Average pain Change6 month - how often6 month - How long6 month - FRI Score6 month - FRI Score Change6 month - Overall, how feel compared to prior to the procedure?6 month Percent (%) change

Adkins Sarah3/1/12NoPL/DexBILATERAL L1-L2 & S1 TF ESI WITH PL/DEX ADD PROLOTHERAPY T12-S1, BILATERAL SI JOINT INJECTIONF3843644452.50020-41130.0-22.585%0020-41132.5-20190%

Aiello Tyler12/22/11YesPL/DexBILATERAL L5-S1, S1 TF ESI PL/DEXM36181084460.00697-14452.5-7.5150%169804455.0-5225%

Alger Sharon6/1/12NoPL/DexLUMBAR TF ESI c PL/DexF4916974485.00062-52060.0-25.0150%00

Anand Sheel G.12/2/11NoPL/DexLUMBAR TF ESI c PL/DexM4011114430.6011104422.2-8.30213214437.570-10%

Anderson Specher Chris1/26/12NoPL/DexRIGHT S1 TF ESI / CAUDAL WITH PL/DEX-ADD BILATERAL SI PROLOM5511643245.000.00021-31230.0-15120%

Andrews Denise4/19/12NoESIBilateral C4-5F46137534239503462.50.030%00

Andriuska Viktoras12/15/11NoPL/DexLUMBAR TF ESI c PL/DexM4010633333.300.000

Anson Byron1/5/12YesESIRIGHT SI JOINT INJ ADD RIGHT S1 TF ESIM54171084492.500.0139804457.5-354

Antis Jeremy5/31/12NoESIBILATERAL C5-C6 TF ESIM3514874450.000.000

Archer John4/5/12NoESIBILATERAL L4-L5, L5-S1 TF ESIADD BILATERAL L4/S1 IAFM68141074458.300.000

Arena John12/15/11NoESIBIL. L3-L4,L4-S1 TF ESIM4818984495.0289804480.0-15.0228803485.0-102

Babb Shirley5/10/12NoPL/DexBILAT KNEES - B L5-S1 TF ESI c PL/Dex & T11-12F7021100036.1033331045.08.9150%00

Bain Kristen5/10/12NoESIBILATERAL S1 TF ESI BILATERAL SI JOINTF3714462.500.000

Barbouti Loretta12/8/11YesPL/DexBIL SI TF ESI c PL/Dex, R SI JOINTF7210111010.000.000

Bazos George12/7/11NoPL/DexLUMBAR TF ESI c PL/DexM3911211020.000.000

Beavers David A.6/14/12NoESIBILATERAL L5-S1, S1 TF ESIM5425753472.20132-32137.5-34.7085%00

Beberniss Deb5/17/12NoPL/DexL5-SI BilateralF4615763450.000.000

Bell James5/11/12NoPL/DexLEFT FEMORAL NERVE INJECTION WITH PL/DEXM50202211005203250.00.0125%00

Bernatis David3/8/12NoESIBILATERAL T12-L1 TF ESIM1521854480.600.000

Bickerton Larry5/9/12NoPL/DexBILATERAL L5/S1 TF ESI C PL/DEXM61113110012102022.50.0210%00

Bishop Freda4/4/12NoESIRIGHT C7-T1, T1-T2 TF ESIF4713434441.7155521035.0-6.7200

Bossert Glenn5/15/12NoPL/DexLUMBAR TF ESI C PL/DEX - L5/S1, S1M5710323250.000.000

Brown Charles V. Jr6/13/12NoESILEFT L5-S1,S1 TF ESIM6816764458.3138604465.06.7300

Brown John4/12/12NoESILEFT C4-C6 TF ESIM5722753337.5127503257.520.0240%137501255.0182-10%

Brown Patricia6/14/12NoESIRIGHT C4/5, C5/6 TF ESIF4013864457.500.000

Busatti Robert1/19/12NoPL/DexBIL. S1 TF ESI- WITH PL/DEXM5734973265.000.000

Butler Angelina2/23/12NoESIbil. l5-s1 s1 tf esi add bil si jointsF8218984472.50455-31050.0-22.5150%00

Campbell Vera Anne1/13/12NoPL/DexLUMBAR TF ESI c PL/DexF6211411042.503521100.0150%013101030.0-13060%

Cargas, Jack6/28/12NoPL/DexM5212863255.600.000

Charalambous Yvonne12/7/11NoPL/DexRGXX-PLDisc - BILAT L2-L5 TF ESI c PL/DexM73177744104460.00.0300

Chyc Wei-Kheng10/20/11NoESIBILATERAL L5-S1, S1 TF ESIF51261073200.0485-23277.5030%

Cole Cheryl A.7/7/11NoESIRIGHT C5-C6, C6-C7 TF ESIF5417964475.000.000

Collins Judith Ann3/7/12NoPL/DexLeft L3-L5 TF ESI with PL/DexF5931533037.537523250.012.5016412044.47125%

Colman Craig3/27/12NoPL/DexL SPINE/C SPINE - PL/DexM6412853252.800.02374-13455.0220%

Conn Gary6/7/12NoPL/DexBILATERAL C5-C6, C6-C7 TF ESI WITH PL/DEXM681393147.2056502247.50.3130%00

Conn Vera6/8/12NoPL/DexLUMBAR TF ESI c PL/DexF6414864465.00354-24462.5-2.5230%00

Conners Pam5/3/12NoESIBILATERAL L5-S1, S1 TF ESIF4812532130.000.000

Cornejo, Everado3/21/12NoESIBILATERAL S1 TF ESI/ CAUDALM3913853467.500.000

Curtis, Jimmy6/28/12NoESIM3914754475.000.000

Darrah Michael M.3/8/12NoPL/DexBIL S1 TF ESI c PL/DexM5216863250.0048602267.517.5220%0221-51010.0-40090%

Davis John1/6/12NoESIBILATERAL L5-S1, S1 TF ESIM49234444047512242.50.01027512140.00150%

Dawes Paxton5/30/12NoESIBILATERAL L4-L5 SNRBBCBS- NO SEDATION.M43151094447.50123-61232.5-15.0150%00

Day Alec10/26/11NoPL/DexBILAT RIBS- ANTERIOR- PL/DEX X2M3536764475.000.000

De Tullio Donna2/2/12NoPL/DexBILATERAL C4-C5, C5-C6 TF ESI WITH PL/DEXF5110411115.0005212022.57.5175%102101112.5-3080%

Deal Rae1/19/12NoESIBILATERAL L5-S1, S1 TF ESIF4814973482.51285-23385.02.52000

Decker Clinton12/22/11NoESIBIL L4-L5,L5-S1 TF ESIM3443963465.000.0269824490.0254-80%

Dee Timlin Delores5/10/12NoPL/DexBIL S1 TF c PL/DexF7010004400.000

Dirico Frank1/12/12NoPL/DexBILATERAL C3/C4, C4/C5 TF ESI PL/DEXM4710000007.50.0080%00100112.50080%

Domalpalli Rajnesh6/12/12NoPL/DexL4-L5, L5-S1 TF ESI & FACET INJECTIONS c PL/DexM5022643252.500.000

Dooley Gwen1/11/12YesPL/DexBILATERAL L4-5, L5-S1 AND ACL/MCL POST- SAME DAY WITH PL/DEXF7211322137.50020-21122.5-15.0000

Dunne Karen4/24/12NoPL/DexLeft L3-L4 TF ESI PL/DEXF4413851232.50020-50017.5-15.0160%00

Dunnigan Alexa5/26/11NoPL/DexBIL L5-S1, S1 TF ESI c PL/DexF2213864452.500.0158713255.03310%

Dye Sheryl1/24/12NoPL/DexBIL S1 TF ESI c PL/Dex.F5513753257.500.00153-22125.0-33160%

Edelman Nichole12/8/11NoPL/DexRIGHT L4-L5,L5-S1 (COUNT 1/2 HEIGHT DISC @L5-S1) PL/DEX TF ESIF1732852125.00051-42122.5-2.510042-32015.0-10070%

Egnatovich Robert9/8/11YesPL/DexBIL L5-S1, S1 + L1-L2 TF ESI c PL/DexM4313964480.000.0139714455.0-253-20%

Elder Stacy5/8/12NoESILEFT C5-C6, C6-C7 TF ESI NOF4511311212.500.000

Elder Stacy6/26/12YesPL/DexLEFT C6-C7 TF ESI WITH PL/DEXF4520211020.000.000

Elrefai Alaa5/22/12NoPL/DexBIL L4-L5, L5-S1 TF ESI c PL/DexM5610312012.5002101015.02.5075%00

Enlow Linda6/2/12YesPL/DexL4-S1 ESI pl dexF59100.000

Erbe Kevin4/10/12NoPL/DexPL/DEX: BILATERAL S1, BILATERAL SS/IS WITH PL/DEXM4912422330.000.000

Espinoza Fabian1/19/12NoESIBILATERAL L3-L4, L4-L5 TF ESIM4718883427.800.01272-63463.9363

Esses Melissa5/11/12NoESIBILATERAL L5-S1, S1 TF ESIF431101094492.500.000

Farmer Chad E3/21/12NoESIRIGHT L3-L4, L4-L5 TF ESIM3913974470.000.000

Farmer Chad E4/12/12YesPL/DexBILATERAL L5-S1, S1 TF ESI WITH PLM39231084485.00775-33165.0-20.0120%00

Fenwick Steven3/6/12NoPL/DexPL/DISC; BILATERAL L2-L5M5310532030.000.0155000%

Fereidooni Alireza5/24/12NoPL/DexL5-SI RightM3527984482.50587-14482.50.0115%00

Ferris Clinton5/24/12NoPL/DexL4-SI,SI BilateralM781041101010-11020.00.0110%00

Figler Sharon5/2/12NoESIBILATERAL S1 PL ESIF5318994490.000.000

Fitzgerald Theresa5/3/12NoPL/DexBILATERAL L4-S1, S1 TF ESI WITH PL/DEXF5412983275.00163-51152.8-22.2170%00

Fitzgerald Timothy10/26/11NoPL/DexLumbar TF pldexM4224753455.00153-23430.0-25.0075%274-13432.5-23

Flessner Nathan5/8/12YesPL/DexLEFT L3-L4LEFT L5-S1, S1 TF ESI WITH PL/DEX X3, Q 3M1924974452.51596-14452.50.025%00

Foley Frank1/12/12NoPL/DexAD L KNEE - BIL L5-S1, S1 TF ESI c PL/DexM60100005.01000002.5-2.5300

Franz Stephanie1/26/12NoPL/DexBILATERAL L2-L3, L3-L4, L4-L5, S1 TF ESI PL/DEXF5211863257.500.0018603265.08350%

Frasor Theresa5/10/12NoPL/DexRIGHT SI TF ESI, RIGHT SI JOINT INJECTION ADD PL/DEXF5713653240.01254-12137.5-2.530%00

Frederick Elizabeth12/13/11YesPL/DexLUMBAR TF ESI c PL/DexF7011631042.500.0107301136.1-64

Fry, Charles6/28/12NoPL/DexBILATERAL L3/L4; L4/L5; L5/S1 TF PL/DEXM4222852252.500.000

Garduno Robert12/15/11NoESIBILATERAL T7-T8, BILATERAL T11-12 TF ESIM2713753357.500.0147503357.50235%

Garrett Shauna1/26/12NoESIBILATERAL L5-S1, S1 TF ESI ADD SI JOINT INJECTIONF34361084480.0710804487.57.519107-14482.5330%

George, Kathleen6/27/12NoESIF5512743262.500.000

Gerson Chartles DR. PHD4/20/12NoPL/DexUMBAR TF ESI c PL/DexM7710312022.5113212025.02.525%00

Girten Susan1/26/12NoESIBILATERAL L5-S1, S1 TF ESF52100.0178703262.50220%

Glasser Joan6/9/11NoPL/DexBILATERAL CERVICAL ESI c PL/Dex,F64100.000

Gonzales Maria M10/20/11NoPL/DexBILATERAL L4-L5, L5-S1, S1 TF PL/DEX ESIF4421443202840330.0150%00

Good David1/26/12NoPL/DexBILATERAL SI TF ESI WITH PL/DEXM4813644430.0057624427.5-2.530%1253-13225.0-530%

Greenstreet Greg12/15/11NoESIT7-8 TF ESIM441286460.000.000

Guillory Delery3/19/12NoPL/DexLUMBAR TF ESI c PL/DexM56121054400.02273-23247.504-15%

Gunn Jessie M.6/12/12NoESIBILATERAL S1 TF ESI WITH PL-MF9614764460.0000.000

Hagaman Kari1/9/12NoESILEFT C5/C6, C6/7 TF ESIF47100.0027401127.50225%

Hagedorn James3/28/12NoPL/DexLUMBAR TF ESI C PL/DEX - L4-L5, L5-S1M6111422237.5015202022.5-15.0130%1031-12022.5-15130%

Hardacre Richard3/19/12NoPL/DexBILATERAL C4-C5, C5-C6 PL/DEXM6217982162.50152-61120.0-42.5099.90%2797-14157.5-52-10%

Harding Gregg2/9/12NoPL/DexRIGHT C5-C7 TF ESI WITH PL/DEXM4413531025.000.000

Harris James12/8/11YesPL/DexLEFT L4/5, L5/S1, S1 TF PL/DEXM32100.000

Hartley Scott5/7/12NoESIBILATERAL S1 TF ESIM4812644247.500.000

Hawron Denise4/3/12NoPL/DexLUMBAR DISC PATIENT - LUMBAR TF ESI c PL/DexF4815874475.00576-12436.1-38.9165%00

Hazen Louis3/13/12NoPL/DexBILATERAL L4-L5, L5-S1 TF PL/DEXM46151074487.5179924485.0-2.5210%00

Heiser Michael5/26/11YesPL/DexBIL L4-L5, L5-S1 TF ESI c PL/Dex.M5814853245.000.00121-40112.5-33090%

Hestera David12/23/11YesPL/DexBIL L5-S1, S1 TF ESI c PL/DexM5021633452.500.0015303250.0-3160%

Hickman Jeff12/28/11NoESIbilateral l4-l5, l5-s1ESIM3813964465.000.000

Hill Carolyn5/14/12NoESIRIGHT L3/L4 TF ESIF4912532155.600.000

Hodd Deborah5/10/12NoESIBILATERAL SIBILATERAL L5-S1, S1 TF ESIF6415763477.500.000

Holaway Michele D.6/19/12YesPL/DexBILATERAL L5-S1, S1 TF PL/DEXF5223753245.000.000

Holmes Terry L.3/22/12NoESIBILATERAL L5-S1, S1 TF ESIF5714863457.5158604462.55.025%00

Hubchik Josephine6/7/12NoPL/DexRIGHT L4-S1, S1 TF ESI WITH PL/DEXF57151084467.52486-2420.0300

Hughes Brian2/23/10NoESIL3-SI SI BilateralM5510004417.500.000

Hussuen, Omar A.6/28/12NoPL/DexL4-SIM2933653157.50243-22017.5-40.0175%00

Jent Darrell Jr.3/22/12NoPL/DexBILATERAL L1-L2 & S1 TF ESI WITH PL/DEX ADDM4454954485.0374-14477.5-7.5068503482.5-3210%

Kachele William5/8/12NoPL/DexLUMBAR PL/Dex - LUMBAR TF ESI c PL/DexM5312843062.5037401045.0-17.5280%00

Keany Karen11/17/11YesESIBILATERAL L5-S1, S1 TF ESIF5113741265.000.000

Keany Karen12/15/11YesPL/DexBIL L5-S1, S1 TF ESI c PL/Dex.F5133963470.000.00184-22260.0-10150%

Keel Jennifer1/12/12YesESIBILATERAL C5-C6 TF ESIF3714984445.000.000

Keel Jennifer2/23/12YesPL/DexC5-C6 bilateral PL/DEXF3722643452.5057513252.50.0095%1050-41122.5-30190%

Kelley Ronda12/8/11NoESILEFT L5-S1, S1 TF ESIF5223543352.800.0127513475.022320%

King david3/14/12NoESIWrist Plex RightM7212672035.000.01555-23230.0-53

Klein Woodard Julie3/16/12NoPL/DexBILATERAL L4-L5, L5-S1 PL/DEXF4623533452.500.0134303247.2-5330%

Kuhn Victor10/31/11NoESIBIL. L5-SI , SI TF ESI AND BIL L4-SIM3316974450.000.000

Laine Robert3/8/12NoPL/Dexbilateral l4-l5 iaf with over fill, bilateral s1 tf esi with pl dex.M4719994265.000.00666-34463.9-1150%

Larson Dave6/7/12NoESIBILATERAL T10-T11, L1-L2 TF ESIM4213963444.400.000

Larson, Craig6/26/12NoPL/DexLUMBAR TF/ESI C PL/DEX - PL BILATERAL S1M4112431047.5137521152.55.025%00

Lauer Ronald1/20/12NoPL/DexLUMBAR TF ESI c PL/DexM66114234012202025.00.0080%0131-1020.00080%

Lilly Barton4/15/11YesPL/DexPL/DEX, BILATERALL4- L5, L5-S1, S1 TF ESIM7031633200.000

Llyod Leonia6/20/12NoPL/DexLUMBAR TF ESI c PL/DexF6214863455.0147712065.010.030%1575-12457.5230%

Londo Patrick6/6/12NoPL/DexLUMBAR TF ESI c PL/DexM6914653436.100.000

Lord Michael4/11/12NoPL/DexBILATERAL L3-S1, (NOT S1) TF ESI ADD PROLOTHERAPYADD PL/DEXM5534963452.5475-13255.02.50383-32150.0-3150%

Lovell Dianne6/7/12NoPL/DexRIGHT L4-S1, S1 TF ESI WITH PL/DEXF5414954460.000.000

Macklin Jenenne4/4/12NoPL/DexLUMBAR TF ESI c PL/DexF5718883333.300.000

Maestas Suzanne4/26/12NoPL/DexLEFT L5-S1, S1 TF ESI WITH PL/DEX add focus at L4-L5F7141853245.01010-50Blank27.5-17.5075%00

Manna Christine5/24/12NoPL/DexR S1 TF ESI c PL/Dex,F5210621012.500.000

Marr Peter5/24/11NoPL/DexLUMBAR TF ESI c PL/Dex.M561071107.500.0003101210.03095%

Martinez Chase1/19/12NoPL/DexBILATERAL L4-L5, L5-S1 TF ESI WITH PL/DEXM5037983455.000.0997-12160.05225%

Martinez David1/19/12NoESIBILATERAL C6- C7 TF ESIM6415753235.0037502240.05.0225%137503247.51320%

Mason Gary4/5/12NoESIM5112852236.30254-14437.51.3170%00

Mccarthy John6/20/12NoPL/DexM5710421125.000.000

Mcfarren Jodi1/4/12NoESIC1-C3 IAF+ BIL. T10-T11 TF ESI/ BIL. T11-12 IAFF441016402257.50.00100%00

Mcnaughton Jens2/16/12NoESIL5- S1 S1 bilateralM4011211130.000.000

Melton Shari12/20/11NoPL/Dexleft l5-s1, s1 tf esi with pl/dexF4410642257.500.000

Michaels Gus5/1/12NoESIBILATERAL L5-S1, S1 TF ESI NO ANEST. UNDER X-RAY NO ANESTM4114873200.000

Mickel John3/8/12NoPL/DexBILATERAL L5-S1, S1 TF PL/DEXM2616434255.000.000

Moler Nancy4/19/11NoPL/DexBIL L4-SI, SI TF ESI c PL/DexF5521211020.000.0103212115.0-5160%

Monk Cheryl11/18/11YesPL/DexLTBD- LUMBAR ESI WITH PL/DEXF4244741147.51111-31045.0-2.5125%0132-21037.5-10130%

Montle Joline5/15/12NoPL/DexBILATERAL C7-T1 IL ESI WITH PL/DEXF6410913016433362.50.0110%00

Mornes David6/7/12NoPL/DexLEFT L5-S1, S1 TF ESI WITH PL/DEXM4214763245.01454-24440.0-5.0220%00

Morrissey Robert1/12/12NoESIBILATERAL L4-L5, L5-S1 TF ESIM6211953060.000.000

Morrissey Robert2/9/12YesPL/DexBILATERAL L4/L5; L5/S1 TF ESIM62121053165.000.00833263.9-1

Moser, Connie6/29/12NoPL/DexPL DISC C5/C6F6214642120.00122-21015.0-5.0150%00

Mundt Lonnie12/1/11YesPL/DexPL/DEX LUMBARM4013863452.50375-14237.5-15.020264-244060%

Munson Bret1/10/12NoPL/DexLUMBAR TF ESI c PL/DexM3510212119.400.000

Olaughlin Coleen1/23/12NoESIBILATERAL C6/7 TF ESIF51100.000

Olorunsola Margaret3/8/12NoESIleft s1 tf esi with pl/dexF6110531138.90052-11135.0-3.9180%00

Oray Martin5/10/12NoESIBILATERAL L5-S1, S1 TF ESIM4412844475.0128514477.52.530%00

Orendorff Donald5/31/12NoPL/DexRIGHT L5-S1, S1 TF PL/DEXM5412533232.5188524455.623.1200

Padilla Devan12/8/11NoPL/DexBILATERAL L5-S1,S1 TF ESI WITH PL/DEXM24171094495.01710904495.00.030%00

Pearce Penny2/9/12NoPL/Dexbilateral t10-11 tf esi with pl/dexF5610743355.00000-4012.5-42.5080%028733352.5-3150%

Pellettera Joyce D.2/16/12NoESIL4-SI Si bilateralF6424852165.01264-11157.5-7.5150%037501052.5-13150%

Petitto John4/20/12NoPL/DexBIL L5-S1, S1 TF ESI c PL/DexM7014543442.500.0246512050.082

Petri Charles12/22/11NoPL/DexBIL S1 TF ESI c PL/DexM4611731227.500.000

Plienis Erin2/2/12NoPL/DexBILATERAL L5-S1, S1 TF PL/DEXF3417874480.000.000

Plowman Ross T10/20/11YesPL/DexBILATERAL L5-S1, S1 TF PL/DEXM7411621255.000.000

Price Paul1/5/12NoPL/Dexbil. l5/s1, s1 tf esi with pl/dex x3M6012843257.51431-31132.5-25.0180%138622252.5-5210%

Purcell Sandon5/1/12NoPL/DexBILATERAL L4-L5, L5-S1 TF ESIM4924863260.0020-6110.000

Putman Janyce1/17/12NoPL/DexBIL L5-S1, S1 TF ESI c PL/DexF421192052.500.000000019.4-330

Quintana Nora12/15/11YesPL/DexBILATERAL L5-S1, S1 TF ESI PL/DEX 12-15-11F4015974452.500.01364-31150.0-31

Rea Mary Lu5/24/12NoPL/DexL5-SI BilateralF5011632242.5125302240.0-2.5225%00

Reeves Laura2/16/12NoPL/DexBIL L4-L5, L5-S1 TF ESI c PL/DexF5118884480.000.000

Regan Gale1/12/12NoESIBILATERAL C6-C7 TF ESIF5124874457.5149703247.5-10.0225%1710814462.5530%

Reilly Barbra5/1/12NoPL/DexPL/DEX.F6125543133.30142-22022.5-10.8160-70%00

Reynolds, Carmen5/15/12NoPL/DexBIL. C6-7 TF ESI WITH PLF5913642155.001240.0-15.0150%00

Richey Jeff10/18/11NoESILEFT L4 - S1 S1 TF ESIM5911632027.500.0026301127.50175%

Rini Darlene1/5/12NoPL/DexBIL L5-S1, S1 TF ESI c PL/DexF3313434452.500.0123303435.0-18160%

Rivera Ronald R (tony)12/22/11NoESIBILATERAL L5-S1, S1 TF ESIM5925973457.51786-1320.01695-23267.510150%

Roberts Donna2/2/12NoESIBILATERAL L3-L4, L4-L5 LOW DOSE TF ESIF6611433442.5033303142.50.020132-13235.0-8150%

Roscoe John4/13/12NoPL/DexLUMBAR TF ESI c PL/DexM4911322132.500.000

Ross Michael2/14/12NoESIBILATERAL L5-S1, S1 TF ESI NOM5118863080.000.000

Roti Sam11/22/11YesPL/DexBIL L5-S1, S1 TF ESI c PL/Dex 11-22-11M5313753452.50254-11027.5-25.0110%037502162.510150%

Ryan Matthew2/8/12NoPL/DexLUMBAR TF ESI c PL/DexM5611423247.2006201022.5-24.7175%0031-11122.5-25140%

Salenieks Karina6/21/12NoESIL5-SI, SI BilateralF3610640220.0107511025.05.030%00

Samsel Bryan12/8/11NoPL/DexBIL L4-L5, L5-S1 TF ESI c PL/DexM4133863355.0385-12240.0-15.000

Sanfilippo Anthony5/23/12NoPL/DexBILAT L4-L5, L5-S1 TF ESI c PL-M/DexM4330833450.0108412135.0-15.030%00

Sass Louis12/15/11NoESIRIGHT L4-L5, L5-S1 TF ESIM6710432140.000.000

Sass Louis1/26/12YesPL/DexBIL L2-L3, L3-L4, L5-S1 TF ESI c PL/DexM6731223322.500.000

Scarbeary Donald5/30/12NoPL/DexBILATERAL L5-S1, S1 TF PL/DEXM6232422035.00120-21327.5-7.5150%00

Schafer Doreen4/2/12NoESIF5516874490.000.000

Schaler Richard2/21/12NoPL/DexBILAT TF ESI c PL/DexM56100.000

Schamel Randy3/12/12NoESIBILATERAL L5-S1, S1 TF ESI NOM5318984472.500.000

Schumacher Stephen2/9/12NoESIBILATERAL L5-S1, S1 TF ESIM48101053262.500.000

Schwan Steven DR.5/24/12NoESIL5-SI ,SI BilateralM61131063370.00111-5340.0085%00

Sempson Judith2/16/12NoESIBILATERAL L5-S1, S1 TF ESI NO ANEST.F57100.000

Shaffer Tracy1/9/12NoESILEFT L5 + S1 TF ESIF5414763450.01763-32252.52.54-40%1143-33432.5-183

Sheesley Melody11/17/11YesESIbilateral l4-l5 tf esiF5114973266.700.00374-33352.5-14190%

Shelton Chris5/10/12NoESIBILATERAL L5-S1, S1 TF ESIM4214974462.5049703355.0-7.5215%00

Shockley Dennis5/8/12NoESIREPEAT ESI LUMBAR - BILATERAL L4-L5, L5-S1, S1 TFM5923873477.5496-13282.55.000

Simone Ahuva4/19/12NoPL/DexBILATERAL C5-C6; C6-C7 IAF PL/DEXF651710104490.00555-53450.0-40.0125%00

Smedley Cliff5/10/12NoPL/DexBILATERAL L4-S1, S1 TF ESI PL/DEXM5011524447.500.000

Smith Aaron1/5/12YesESIBILATERAL T8-T9, L4-L5 TF ESIM3612753262.500.000

Smith Aaron2/16/12YesPL/Dexbilateral t8-t9 tf esi/right l5-s1, s1 tf esi with pl/dexM362274265.000.038623262.5-3

Soldner Donna3/22/12NoPL/DexmaryF6120100015.011111322.57.520%114223030.0154-30%

Soodoo Nancey6/19/12NoPL/DexF5314854157.500.000

Spangler April1/26/12NoESILEFT T8-9 TF ESIF3323863457.5374-22253.8-3.700

Spangler April4/5/12YesPL/DexBILATERAL T8-T9 TF ESI WITH PL/DEXF3413742253.800.000

Sprung Thomas5/24/11NoPL/DexPL/DEX, BILATERAL L3-L4, L4-L5, L5-S1M5611753240.000.000

Stanulonis Mary4/12/12NoESIF5613444400.000

Steinmetz Sally5/27/11YesPL/DexBILATERAL L4-L5, L5-S1 L KNEE PL/Dex INJECTIONF7312843450.000.000

Stokoe Shirley4/26/12NoESIRIGHT S1 TF ESIRIGHT SI, ADD RIGHT KNEE PESF7613753261.10132-3100.0175%027503400

Stookey Deann4/19/12NoPL/DexL4-5-SI BilateralF4813854452.5038613242.5-10.0215%158503245.0-8210%

Sturm John4/11/12NoPL/DexBILATERAL S1 TF ESI WITH PL.M7512431017.500.000

Surer Tammy2/16/12NoPL/DexCERVICAL LUMBAR PL EPIDURALSF39141084475.00274-41252.5-22.5225%0595-31355.0-20175%

Templar Dennis4/5/12NoESILEFT L4-L5, L5-S1 TF ESIM7611324400.000

Tilghman Paula A.12/23/11YesESIBILATERAL L3-L4, L4-L5 TF ESIF5825741255.000.00031-31122.2-330100%

Trumble Timothy1/17/12NoESIRIGHT L5-S1, S1 TF ESI LOW DOSE UNDERM5121424435.000.000

Turi Mark11/8/11NoPL/DexBILATERAL L5- S1 AND S1 TF ESI WITH PL/DEXM4411953450.000.000

Underwood Mike5/17/12NoPL/DexLUMBAR TF ESI c PL/DexM5113754465.0158724467.52.5310%00

Vahling Nancy10/17/11NoESIBILATERAL L5- S1 TF ESIF4013751000.000

Vanden Bom Elaine4/18/12NoPL/DexBIL L5-S1, S1 TF ESI c PL/DEX -; BILATERAL L4-L5 IAF;F4014764485.000.000

Vanlieshout James1/19/12NoPL/DexBILATERAL S1 TF ESI, CAUDAL WITH PL/DEX X3 ADD BILATERAL SI JOINTS, RIGHT IA AND L3-S1 SS /IS HACKETM5322434432.51242-14447.515.030%024304435.03215%

Von Briese Kamm Constance3/23/12NoPL/DexBILATERAL L5-S1, S1 TF PL/DEXF58100.0233304402

Wakeham Donald5/22/12NoPL/DexBIL L4-L5, L5-S1 TF ESI c PL/DexM6414441132.500.000

Waldner Lars4/17/12NoPL/DexL L5-S1, S1 TF ESI c PL/DexM53102111122211112.50.0200

Ward Jack1/5/12YesESIBILATERAL L3/L4, L4/L5 TF ESIM6115864485.000.000

Warner Sandra2/23/12NoPL/DexL4-L5 Bilateral PL/DEXF551010104400.000

Watkins Richard D5/10/12NoPL/DexL4-L5, SI BilateralM6130523142.522642320.03-10%216313250.083

Watlington TylerAnn4/5/12NoPL/Dex1. BILATERAL S1 TF ESI WITH PL/DEXF5124862150.000.000

Wegher Jeff5/30/12NoPL/DexBILATERAL S1 TF ESI WITH PL/DEXM3910421222.500.000

Wegher Jennifer5/30/12NoPL/DexBILATERAL L3-L5 TF ESI WITH PL/DEXF412264341142-23252.80.0200

Westbrook Ellen1/19/12NoESIBIL SI TF ESIF6323533242.5034303444.41.9135301135.0-81

Wildgrube Rodrick5/26/11YesESIRIGHT C5-6, C6-7 TF ESIM5823863439603255.00.00300165%

Williams Nacy12/20/11YesESIbilateral l5-s1,s1 tf esiF53141073477.500.000

wilson Stephen5/4/11NoPL/DexPL/DEX L5-S1, S1 TF ESI.M6212633240.000.000

Winter Ladessa6/14/12YesESILEFT L5-S1, S1 TF ESIF8323733461.1248853465.03.94-90%00

Wonderly Mary4/6/12NoPL/DexKNEES, LUMBAR TF ESI WITH PL/DEXF69161084480.00354-43436.1-43.9175%00

Wood Gary1/5/12NoPL/DexBILATERAL L5-S1, S1 TF ESI PL/DEX ; PROLO SS/IS L1-SM6830323422.200.000

Yeoman Ellen4/20/12NoPL/DexLUMBAR TF ESI c PL/DexF5913984485.0119804485.00.0300

Youch Glenn3/27/12NoPL/DexLUMBAR TF ESI c PL/DexM611496340375-14455.00.0150%00

Zimba Kenneth12/13/11NoPL/DexRGXX PLDex - LUMBAR TF ESI c PL/DexM6412643247.50253-12232.5-15.0175%0153-13137.5-10175%

Pivot

Row LabelsCount of Patient NameCount of GenderAverage of AGE

ESI85.0085.0051.42

F424253.3333333333

M434349.5581395349

PL/Dex147.00147.0052.18

F626252.6129032258

M858551.8705882353

Grand Total23223251.9051724138

Mean Charts

Row LabelsnPreop - Average painnPreop - FRI Scoren3 month - Average painn3 month - FRI Scoren3 month Percent (%) changen6 month - Average painn6 month - FRI Scoren6 month Percent (%) change

ESI795.427258.34314.772854.49200.31234.782353.85180.32

PL/Dex1394.2812748.41733.377040.87590.40533.475140.34450.39

Mean Charts

ESI

PL/Dex

Average Pain

Mean Change

ESI

PL/Dex

FRI Score

ESI

PL/Dex

Percent Improvement

Row Labelsn - 3 mo3 month - Average pain ∆n - 6 mo6 month - Average pain ∆

ESI300.73210.86

PL/Dex711.00500.72

Row Labelsn - 3 mo3 month - Average FRI ∆n - 6 mo6 month - Average FRI ∆

ESI242.41190.58

PL/Dex609.65487.62

ESI

PL/Dex

Average Pain Decrease from Baseline

ESI

PL/Dex

FRI Score Improvment from Baseline

PL for Radicular PainThe use of lumbar epidural injection of platelet lysate for treatment of radicular pain. Centeno. Journal Experimental Orthopaedics (2017) 4:38

470 patients (265 male and 205 female) Mean Age: 53.6 Mean BMI: 26.5 6.2% Adverse events

79.3%: pain, inflammation, soreness, muscle tightness and numbness

20.6%: nausea, emesis, light-headness, skin sensitivity, swelling

The use of lumbar epidural injection of platelet lysate for treatment of radicular pain. Centeno. Journal Experimental Orthopaedics (2017) 4:38

PL for Radicular Pain - FRI

PL Epidural Conclusions

Safe No serious AEs !!!

Potentially equal or better pain reduction and improved function compared to CSIs

More tedious to produce/perform Much more rigorous study on safety and efficacy required!

STEM CELLS FOR SPINE (DDD)

THOSE WHO FORGET HISTORY …..

Intradiscal Platelet-Rich Plasma Injection for Chronic Discogenic Low Back Pain: Preliminary Results from a Prospective Trial. Levi et al., 2016

22 Patients

• 9 Single Level• 10 Two Levels• 2 Three Levels• 1 Five Levels

Outcome [VAS >50% & ODI >30% Improvement]

1 month: 14% 2 months: 32% 6 months: 47%

Intradiscal Injection of Autologous Platelet-Rich-Plasma Releasate for the Treatment of Discogenic Low Back Pain -Preliminary Prospective Clinical Trial of - 12 CasesORS 2013 Annual MeetingAkeda, K. etal.

Chronic low back pain without leg pain for more than 3 months One or more lumbar discs (L3-4 to L5-S1) with evidence of

degenerative changes on magnetic resonance imaging (MRI) At least One symptomatic Disc confirmed using standardized

Provocative Discography A soluble releasate, isolated from clotted PRP, was injected

(2.0 ml) into the center of the nucleus pulposus under fluoroscopic guidance

Intradiscal Injection of Autologous Platelet-Rich-Plasma & Releasate for the Treatment of Discogenic Low Back Pain -Preliminary Prospective Clinical Trial of -12 CasesAkeda, K. etal. ORS 2013 Annual Meeting

Before Treatment VAS: 7.7±1.2 RDQ: 13.5±3.8 JOA score 19.6±3.1

After Treatment VAS: 3.1±3.2 RDQ: 2.9±4.2 JOA score: 24.3±3.5

Significantly decreased at one month and it was sustained for 12 months after treatment p

Lumbar Intradiskal Platelet-Rich Plasma (PRP) Injections: A Prospective, Double-Blind, Randomized Controlled

Study. Tuakli-Wosornu. Etal. PMR. 2016

RCT with N=47 29 Treatment 18 control Cross over design at 8 weeks Axial LBP >6 month, Failed conservative

Treatment, Positive Discogram, >50% disk height

http://www.ncbi.nlm.nih.gov/pubmed/26314234

Tuakli-Wosornu et al PMR

NO Adverse Events (disc infection, neurologic injury, or progressive herniation)

Improved NPS & FRI vs control at 8 weeks 15/18 Controls crossed over at 8 weeks Maintained benefits with significant difference at 12

months 56% of Patients Treated Satisfied

PRP and Disc (Reviews) Enhancing intervertebral disc repair and regeneration

through biology: platelet-rich plasma as an alternative strategy. Wang S. 2013

What is the preclinical evidence on platelet rich plasma and intervertebral disc degeneration? Formica M et al 2015 Eur Spine

Intradiscal platelet-rich plasma (PRP) injections for discogenic low back pain: an update. Monfett M. et al. 2016

Repair and Regenerative Therapies of the Annulus Fibrosus of the Intervertebral Disc. Li X. 2016

[Platelet-rich plasma (PRP) and disc lesions: A review of the literature]. Charneux L. Neurochirurgie. 2017

What is the clinical evidence on regenerative medicine in intervertebral disc degeneration? Basso M. 2017

https://www.ncbi.nlm.nih.gov/pubmed/29128087

Intradiscal Stem Cell Studies

11/27/2018 44

Haufe, et al. Stem Cells Dev. 2006 Feb;15(1):136-7

10 patients with Symptomatic DDD (axial LBP) Autologous Bone Marrow HSCs Percutaneous injection plus Hyperbaric Oxygen Therapy No improvement in LBP in any patient

8/10 underwent surgery by one year


Yoshikawa et al. Spine 2010 May 15;35(11):E475-80.

2 patients with LBP and radicular symptoms Autologous culture expanded Bone Marrow MSCs Placed during decompressive surgery with collagen

sponge Increased MRI T2 signal, less instability on stress

radiographs, clinical improvement in both patients.

Meisel et al. Biomol Eng. 2007 Feb;24(1):5-21.

28 patients undergoing Microdiscectomy Autologous cultured expanded chondrocytes (not MSCs) Percutaneous injection 12 weeks post microdisc Cell Tx patients had less LBP at 2 years postop Retained MRI T2 signal (hydration) of treated and adjacent

discs


Pilot study with 10 painful, degenerated discs injected with BMC (Autologous & Expanded) All with intact annulus Results examined at 1 year including MRI follow up

▪ MRI did not show any restoration of disk height but did have increased water content at 12 months (0.63 to 0.72)

Improved LBP, leg symptoms, and MRI T2 signal

Transplantation, 2011

Intervertebral Disc Repair with Activated Nucleus Pulposus Cell Transplantation: A Three-Year, Prospective Clinical Study of Its Safety Mochida, et al. European Cells and Materials. 2015

9 patients undergoing Lumbar Fusion 20-29 years old Adjacent disk Pfirrmann’s grade 3 Autologous NP cells from fused disc co-cultured with

autologous BMSCs Injection 7days post op No Adverse Events at 3 years 8/9 maintained disk grade, 1/9 improved


Treatment of Discogenic back pain with autologous BMC injection

26 patients with > 6 months LBP Modified Pfirrmann grade of IV-VII Candidates for surgery BMC was injected into the nucleus pulposus of

the symptomatic disc(s) under fluoroscopic guidance

Pettine K et al. Treatment of discogenic back pain with autologous bone marrow concentrate injection with minimum two year follow-up. Int Orthop. 2016 Jan;40(1):135-40

13 Single level 13 Two levels Modic changes

Results: NO Adverse Effects 9/20 patients with MRI at 1 year showed

IMPROVEMENT by blinded reviewer

Treatment of Discogenic back pain with autologous BMC injection

Results 92 % avoided surgery through 12 months 81 % avoided surgery through 2 years 20 out of 26 patients (77%) showed 1 grade

improvement on 1 year MRI 71 % VAS reduction and > 64 % ODI

improvements through 2 years

Mesoblast (Mesenchymal Precursor cells)Phase I/II FDA Clinical Trial

Double Blind RCT at 13 clinical sites N=100 patients with moderate-severe LBP with DDD 60 patients got two doses of Allogeneic culture expanded MSCs in

hyaluronic acid for single level DDD Improvement in both groups over HA and saline

3.7-4/10 pain reduction in MSC groups 2.7/10 pain reduction in the HA only and saline groups ! ODI: decreased by 35 % in Mesoblast; 30 % HA; 28 % saline. Missed major structural end-point (significant changes in MRI)

Conclusions:

Bone marrow aspiration has the longest and greatest evidence of efficacy for Orthopedic conditions

Consideration for Muscle Injection in Non-Specific Low Back Pain Alternative to Epidural, Facet and SIJ injections instead of

corticosteroids Intradiscal for Chronic Discogenic Pain

Less Evidence for PRP Better evidence for BMAC (Dose Dependent !)

Regenerative Treatment of Spinal ConditionsDiclosuresDisclosures:DisclosuresOutlinePlatelet Rich Plasma (PRP)�and LysateMesenchymal Stem CellsStem Cell SourcesBone Marrow AspirationSlide Number 10BMA v. AdiposeNew System for Harvesting AdiposeIs there ANY Evidence It Works ?????Spinal ConditionsChronic Low Back Pain - �Lumbar Muscle Atrophy�Effect of autologous platelet leukocyte rich plasma injections on atrophied lumbar multifidus muscle in low back pain patients with monosegmental degenerative disc disease. �Hussein, 2016�PLRP - Lumbar MusclesSacroiliac JointSacroiliac Joint�A randomized controlled trial of intra-articular prolotherapy versus steroid injection for sacroiliac joint pain. �Kim WM. etal. 2010�Case series of Ultrasound-guided Platelet-Rich Plasma Injections for Sacroiliac Joint Dysfunction. Ko G. 2017Steroid vs. Platelet-Rich Plasma in Ultrasound-Guided Sacroiliac Joint Injection for Chronic Low Back Pain�Varun Singla, etal.�Facet Mediated PainUsing Intra-articular Inject Facet Joint and PRPA New Technique for the Treatment of Lumbar Facet Joint Syndrome ion with Autologous Platelet Rich Plasma. �Wu. et al. Pain Physician 2016�A Prospective Study Comparing Platelet-Rich Plasma and LA/Corticosteroid in Intra-Articular Injection for the Treatment of Lumbar Facet Joint Syndrome�Jiuping Wu, Jingjing Zhou, et al. 2016A Prospective Study Comparing Platelet-Rich Plasma and LA/Corticosteroid in Intra-Articular Injection for the Treatment of Lumbar Facet Joint Syndrome�Jiuping Wu, et alA Prospective Study Comparing Platelet-Rich Plasma and LA/Corticosteroid in Intra-Articular Injection for the Treatment of Lumbar Facet Joint Syndrome�Jiuping Wu, et alA Prospective Study Comparing Platelet-Rich Plasma and LA/Corticosteroid in Intra-Articular Injection for the Treatment of Lumbar Facet Joint SyndromeRegenerative Treatments for RadiculopathyInjecting Platelet Lysate Instead of Steroid MedicationsCortisone vs PRP EpiduralRegistry data on PL EpiduralsESI vs. PL EpiduralsPL for Radicular Pain�The use of lumbar epidural injection of platelet lysate for treatment of radicular pain. �Centeno. Journal Experimental Orthopaedics (2017) 4:38�The use of lumbar epidural injection of platelet lysate for treatment of radicular pain. �Centeno. Journal Experimental Orthopaedics (2017) 4:38PL for Radicular Pain - FRIPL Epidural ConclusionsStem Cells for Spine (DDD) Those who forget history …..Intradiscal Platelet-Rich Plasma Injection for Chronic Discogenic Low Back Pain: Preliminary Results from a Prospective Trial. �Levi et al., 2016Intradiscal Injection of Autologous Platelet-Rich-Plasma Releasate for the Treatment of Discogenic Low Back Pain -Preliminary Prospective Clinical Trial of - 12 Cases�ORS 2013 Annual Meeting�Akeda, K. etal. Intradiscal Injection of Autologous Platelet-Rich-Plasma & Releasate for the Treatment of Discogenic Low Back Pain -Preliminary Prospective Clinical Trial of -12 Cases�Akeda, K. etal. ORS 2013 Annual MeetingLumbar Intradiskal Platelet-Rich Plasma (PRP) Injections: A Prospective, Double-Blind, Randomized Controlled Study. Tuakli-Wosornu. Etal. PMR. 2016Tuakli-Wosornu et al PMRPRP and Disc (Reviews)Intradiscal Stem Cell StudiesHaufe, et al. �Stem Cells Dev. 2006 Feb;15(1):136-7Yoshikawa et al. �Spine 2010 May 15;35(11):E475-80.Meisel et al. �Biomol Eng. 2007 Feb;24(1):5-21.Slide Number 48Slide Number 49Slide Number 50 Intervertebral Disc Repair with Activated Nucleus Pulposus Cell Transplantation: A Three-Year, Prospective Clinical Study of Its Safety �Mochida, et al. European Cells and Materials. 2015Treatment of Discogenic back pain with autologous BMC injectionSlide Number 53Slide Number 54Treatment of Discogenic back pain with autologous BMC injectionMesoblast (Mesenchymal Precursor cells)�Phase I/II FDA Clinical TrialConclusions: ��

regenerative treatment of spinal conditions · varun singla, etal. 40 patients with chronic low...

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