The Truth About Localization with Image Guidance
Dennis M. Lox M.D. has been doing musculoskeletal injections for decades. He even is a go-to Regenerative Medicine expert for countless medical doctors over the years that trust his knowledge and experience. One Rheumatologist even stated, “ doc you give good shots”. The meaning was simple. If you know what you are doing, it doesn’t necessarily hurt. If you don’t care and are in a rush or brutal, it can be very unpleasant. Having used Fluoroscopy for decades for complicated injections, especially spinal injections, Dr. Lox knows the in and outs of guidance imaging. Dr. Lox began using ultrasound guidance for some procedures about 10 years ago. He is experienced and knows when and how to use each proficiently.
Fluoroscopy and Ultrasound Differences
Fluoroscopy has been, and still remains the gold standard for injections with the need for bone clarification and localization. It is that simple and clear.
Ultrasound developed as a tool in musculoskeletal medicine to look at soft tissues. It has been around for years in cardiology to look at hearts, and obstetrics to see the unborn child. Anyone seeing an ultrasound of a fetus to tell the sex of the child, well it’s not a crystal clear MRI, it’s an art but more like an abstract painting than a fine detail telescope. The purpose was avoiding unnecessary radiation to get a noninvasive look. Now that many musculoskeletal practitioners are using it, they routinely bill for it, just like going to an orthopedic doctor you always seem to need a new x-ray.
Understand? Welcome to the changes in brought on by managed care, and health insurance reforms. Also, it is been used by some large groups touting a routine one size fits all technique to separate those who overzealously market who cannot do injections themselves by law, such as chiropractors.
This is not an attempt to throw stones, just provide patients with truthful scientific answers to questions.
Localization to Tell the Stem Cells Where to Go?
Non-sense. Pure and simple. Why? You can’t tell a Stem Cell what to do.
There was a paper years ago quoted by several doctors to reinforce the need for needle localization. It was called the Kota dripping hypothesis, after the Koga. It was based on the early work of culture expanded stem cells which are no longer allowed in the United States as this is deemed a drug.
Quite simply the thinking was you needed to drip the stem cells over a lesion or particular injured site to help the stem cells stay there. This has carried over to ultrasound guidance.
The truth is culture expanded stem cells change as they divide to create larger numbers. One change is their age dramatically. Almost 30 years. Another very important change no one wants to talk about is stem cells have surface receptors. Many surface receptors capable of reading and processing many pieces of information at once. STEM CELS are SMART. They actually home to signals of injured tissues by surface receptors that act as laser or guided missiles. You simply cannot tell a Stem Cell what to do. Please read up on stem cell surface receptors to verify. Dr. Lox has lectured at Stem Cell Medical Conferences to University Professors on this topic. Dr. Lox does not give seminars to the public on in-depth scientific material. He does so because he is passionate about the field, and shares scientific ideas with his peers.
Fluid In a Container Analogy
If you shake a can of fruit, there is solid fruit and fruit sugar water. The fluid moves around the solid fruit inside a hard metallic can.
A joint is composed of hard bones. Any fluid including stem cells is in a suspension of water (blood products that are mostly molecularly water).
As soon as you weight bear on an injected knee, the fluid moves around inside the lined hard boney joint. The stem cells move with the fluid. As the stem cells are equipped with surface receptors, they will read the environment of the joint and do their job to the best of their ability given the problem. They then can home to specific sites.
Yes, it is important to the get the cells in the joint, but a joint is not a focal hamstring tear different problem different needs. Now a lot of joints have arthritis and meniscal injuries, chondral defects and multiple noted findings on MRI. So now where do you put the cells? It is a global joint problem.
A lot of so-called experts don’t understand this. It needs to be in the joint because it is an arthritic joint, not one tiny area you drip the cells across.
Sadly, it is also a marketing ploy to separate some novice “stem cell practitioners” from others.
Dr. Lox believes in educated each patient for their specific problem with honest answers. There is no one size fits all technique for Regenerative Medicine.
The is an old saying that is profound and true.
“There is the science of medicine and the art of medicine.”
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