by DND | May 11, 2023
The Future of Spinal Injury Treatment | Dr Gregory Lutz
Dr. Gregory Lutz is the Founder and Chief Medical Officer of the Regenerative SportsCare Institute, Physiatrist-in-Chief Emeritus at Hospital for Special Surgery, and a professor of clinical rehabilitation medicine at Weill Medical College of Cornell University. A pioneer in regenerative medicine, Dr. Lutz has co-authored more than sixty scientific publications, including the first double-blind, randomized, controlled study demonstrating the clinical efficacy of intradiscal platelet-rich plasma therapy. Dr. Lutz is the Co-Founder and Executive Chairman of Orthobond Corporation.
In this episode we discuss:
– Common causes of chronic lower back pain and what to do about them.
– What is Regenerative medicine?
– The top three things you can do to improve the health of your back and spine.
– What is Platelet-Rich Plasma therapy, and how can it help you?
– The surprising connection between bacteria, your microbiome, and spinal disc degeneration.
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Greg Lutz, Dr Lyon
Dr. Lyon (01:00:00 -> 01:00:52)
Greg Lutz. Welcome to the Doctor Gabrielle Lyon show. I’m really excited to have you on because you are a regenerative expert and people are very unfamiliar. I think in general about regenerative medicine. And it’s really a very proactive approach to healing. And I’m just gonna read a little bit about you and you are a psychiatrist in Chief Emeritus at the Hospital for special surgery. And for you guys that don’t know, this H S S is considered one of the best in the world. You also are part of W Cornell Medical College, which is incredible and you are a pioneer in regenerative therapy, which this is what this show is all about. You’ve written many scientific studies and contributed to the body of work quite tremendously. So, thank you so much.
Gregory Lutz (01:00:53 -> 01:01:08)
Well, thanks so much for having me, Gabriel. It’s a kind of a, a real pleasure to have the opportunity to, to, you know, share the message about other options for patients than drugs and surgery for their chronic back pain.
Dr. Lyon (01:01:08 -> 01:01:10)
Let’s talk about what is chronic pain?
Gregory Lutz (01:01:12 -> 01:01:56)
you know, chronic pain is usually defined by pain that that doesn’t go away after, you know, three months and you know, that that’s when it starts to, you know, the natural healing process didn’t correct the problem. And you’re living with a fair amount of discomfort, changing your activities of daily living, getting more anxious because you don’t, you don’t know what’s going on and then, you know, you start looking for solutions and sometimes you look for solutions in the wrong places and, and, and, you know, we know with back pain that, you know, drugs and surgery are typically palliative treatments that, you know, they’re not necessarily, you know, getting patients the relief they want for the long term.
Dr. Lyon (01:01:56 -> 01:02:29)
And also when you say palliative treatment, it’s essentially a band aid. It’s this revolving door of now you’re dealing with, uh, injections that potentially are limited and then medications, which medications over time can be debilitating for people, especially pain medication is an addiction component. And also it really affects cognitive function, um, as individuals age, which I’m sure you’ve seen. So how did you get interested in back back and pain in general?
Gregory Lutz (01:02:30 -> 01:03:37)
You know, w w when I came to, um, hospital for special surgery, um, back in the early nineties, you know, they were, they were looking for a, a specialist to manage patients better nonsurgically because so much of the hospital’s focus is on the surgical, you know, correction of deformities and, and joint replacement surgeries and sport surgeries. And so I, I was brought in to say, well, how how can we optimize the rehabilitation of patients? How could we optimize the non surgical treatments? And a lot of that, you know, original time period was spent developing minimally invasive techniques to guide injections of anesthetic and steroids into, into difficult places in the spine. And then over the past 15 years, that’s when I, you know, we, we evolved into more of the regenerative treatments, you know, using the same, you know, interventional technique, but using things that actually can create a cure if we put them in the right place at the right time.
Dr. Lyon (01:03:38 -> 01:03:40)
That’s incredible. Say that again,
Gregory Lutz (01:03:41 -> 01:04:15)
things that can actually create a cure because the cure like getting pain relief is important. But getting structural healing of the tissue that’s damaged is really when you might get a cure and that’s what we need to do. And I think that we need to shift the, the treatment paradigm away from invasive surgeries and, and drugs with a lot of side effects to really more natural ways of healing. And there’s nothing better than using your own cells to create that um process.
Dr. Lyon (01:04:15 -> 01:04:37)
And how does that work in terms of you said, using the cells? And by the way, I’ve had pr P in multiple areas in my body, I’ve had some significant sporting injuries that have caused pain and damage. And uh uh I’m very familiar with the process. I would love for you to take the listener or the viewer through what that actually looks
Gregory Lutz (01:04:37 -> 01:06:27)
like, you know, it’s, it’s really a very simple process. And you know, when we just to give an analogy, when we cut our skin, you know, the first cells that go to the wound are platelets and platelets release their growth factors, which signal stem cells to come to the wound, remodel the tissue and regenerate the tissue. So when there’s damage to tissue that has a good blood supply, that process is pretty much on autopilot. The the problem that arises is when uh tissue that has a poor blood supply gets damaged, and then the healing can be often incomplete or very poor. And structures that have poor blood supplies in the body are typically tendon tissue, cartilage, tissue and a and disc tissue and and the disc is actually the largest structure in the body that has the least amount of blood, you know, very poor blood supply. So, so the process, when we originally thought about using PR P, it was only after we saw such nice results with healing tendon tissues where we would, you know, take the patient’s blood, we would spin it in the centrifuge, concentrate the cells to very high levels and precisely put them into tendons under ultrasound guidance and then reimage and see if the pa the pain relief was correlating with structural healing. And so the same collagen that makes up a tendon makes up some of the outer rings of a disc and, and So that’s when we translated, made that made that, that jump from tendons to disc tissue. But it was really just simple, you know, um path of physiology or biology of tendons and collagen and healing, you know.
Dr. Lyon (01:06:27 -> 01:07:33)
you know, and for the listener, people are thinking, ok, well, what are my tendons? What kind of injury would that be? And I would say, you know, for me, I had a, an avulsion of my hamstring, so I tore the tenant of my hamstring over 80%. And I did two years of PRP in terms of uh initial treatment, it was a very large tea over a period of time. Basically, they come in, they draw your blood, they spin it down and they inject it into the tendon exactly the, the way in which you’re describing under ultrasound, what other areas of the body would be a um a common area of injection. So if someone is sitting at home saying, wow, I have back pain, which nearly everybody I know every single one of my patients at some point or another will talk about that. And then also the athletes in the military, all these guys from jumping out of planes over a lifetime really ultimately get injured. What are some other areas and and kind of uh as it relates to injury, would you say that Pr P F from tendons standpoint?
Gregory Lutz (01:07:34 -> 01:08:02)
oh from tendons standpoint, you know, the the common areas that we typically treat our rotator cuff and the shoulder. Um We do a lot of gluteus meus tendons in the hip hamstring tendons, patella tendons, which are really common in jumping sports, achilles tendons uh which are also common in, in runners. And so the, the, those are the most common areas that we treat with PR P.
Dr. Lyon (01:08:02 -> 01:08:16)
And what is the threshold for uh treatment? For example, if someone comes to you and they say, oh um this is starting to aggravate me, would you go right to PR P? Do you have to see a certain uh percentage of tear? What does that look like? Or tissue injury
Gregory Lutz (01:08:16 -> 01:09:16)
Typically, you know, if it doesn’t heal within six weeks, we’re starting to think about, you know, offering an Ortho biologic option like PRP and, and really the the if the tendon is, is grossly disrupted, you’re not like your, your tendon would be a hard one to treat because it was an avulsion, but there must have been something left as a strut to get some healing. So, but if you have a completely torn achilles, um you’re not a great candidate, but most patients come in with partial tears and, and those are the ones that are very good candidates that, you know, if we can catch it early and get it to heal, then it doesn’t go on to a complete tear. So, so it’s usually either through ultrasound or through MRI imaging, we can see the degree of tear and if patients with, you know, rotator cuff tendinosis, which were just inflammatory changes that aren’t responding to physical therapy, you know, those are also a very good candidate.
Dr. Lyon (01:09:17 -> 01:09:36)
And would you say someone who is lifting or doing some kind of activity and maybe, you know, shoulders are so common, especially as individuals get into their forties. It’s one of the most, it’s one of the most common surgeries do, would you say if you are starting to feel some irritation that you go early as opposed to push through it?
Gregory Lutz (01:09:36 -> 01:11:03)
And it’s, it’s such a nice, this is such a safe treatment that can change the natural history to the, to the, to a more favorable one that if you’re having pain, you know, it’s so easy to get evaluated with an ultrasound and see how the tendon is doing because sometimes it’s just a brys, you know, it’s the cup, the rotator cup looks good and, and, and it may just be a brys and that responds very simply to a simple cortisone injection and some postural changes with exercise. So, so, but that’s, I think the, the reason I wrote the book as it relates to the spine is because in the spine, you know, we don’t want your spine to degenerate. And you know, there’s this concept of the degenerative cascade because when the disc starts to degenerate, you know, then the spinal segment develops instability and then you develops deformity and then you start getting nerve compression. And so what we’ve seen, if we can intervene early and stop that process with a good injection of PR P into the disc to, to stabilize that column, then hopefully, we can prevent long term um siqueli of a degenerative cascade in the spine. And I think that’s, that’s a really good message is, you know, if you’re having pain, it’s not responding or it’s not healing within 3 to 6 weeks, get evaluated.
Dr. Lyon (01:11:03 -> 01:11:11)
And in terms of back pain and back degeneration, is that something that everybody goes through is that considered a normal process of aging?
Gregory Lutz (01:11:11 -> 01:12:14)
No, it’s not normal and it’s not, not, not everyone goes through it. And I think that, you know, there’s a lot more uh we’ve learned about this degenerative process and just like we have a microbiome in our, in our um gut, we have a microbiome in the disc. And what we’re seeing is we thought the disc was a sterile environment. It’s really not, you know, there’s a studies that have shown that there’s over 400 different species of bacteria in the disc. And that a lot of degeneration has been linked to an overgrowth of certain types of bacteria. And so when we do this intradiscal pr P, we’re using a preparation that has a very high, high white blood cell count. It’s called the leucocyte rich pr P. And so we may be killing two birds with one stone with our treatment because the platelets have growth factors which stimulate collagen healing. But then the leucocytes may be suppressing some of the overgrowth of abnormal bacteria in the disk that has been linked to this degeneration.
Dr. Lyon (01:12:15 -> 01:12:19)
I have never heard that before. That is fascinating.
Gregory Lutz (01:12:19 -> 01:12:48)
It’s, it is fascinating and I’ve only learned it over the past few years and so, and you can, you can see how that concept of the disc not being a sterile environment, doesn’t, you know, set up well for putting spinal implants into the spine. You know, because, and I think that’s one of the reasons a lot of the fusions fail is because these implants develop biofilm so that these patients are having persistent pain and loosening after their surgeries.
Dr. Lyon (01:12:48 -> 01:13:03)
And I’m also guessing that that sets up for subsequent inflammation, low grade inflammation in the body and perhaps this degenerative cascade or the decline in health also contribute uh unknowingly to. Um
Gregory Lutz (01:13:04 -> 01:13:42)
yeah, there’s a, there was a, there was a fascinating study out of um it was India that actually took samples from normal young healthy discs. And they used sophisticated DNA analysis and they were able to identify over 424 different species of bacteria inside a normal disc. And so that that was very eye opening and, and then, you know, there’s a lot of data now that suggests that, you know, cutie bacterium acnes, which is the same bacteria that causes acne has been linked to this degeneration.
Dr. Lyon (01:13:42 -> 01:13:59)
How would the next logical question would be, is does nutrition interventions or oral intake interventions have any input or impact within that microbiome of the disc?
Gregory Lutz (01:14:00 -> 01:14:38)
Oh I, I believe it will, it will, I believe it does. And I think as we get more sophisticated, you know, uh ability to, to link with A I, um there’s definitely a, a gut disc access that we see and, and you know, and there’s a higher risk for infection in younger male um patients in the spine because of this, you know, overgrowth of cut bacterium acnes. So, so I think that there’s a lot, we we are only beginning to understand, you know, the role that bacteria play in disc degeneration and it’s not a normal process,
Dr. Lyon (01:14:38 -> 01:15:30)
meaning it’s not a normal process. So, similarly to the gut, when the gut has some kind of small intestinal overgrowth or fungal overgrowth, that is not a normal environment. And you’re saying that that environment exists within the spinal column and even more specifically within those discs in the back. Exactly. Wow. In terms of treatment and in terms of the early onset of treatment, you said that you use a A PRP that is high in white blood cells. Do you augment it with anything else like growth, other growth factors or um you know, I’m sure that people have asked about uh growth hormone and any other kinds of perhaps peptides. Do you utilize any of those
Gregory Lutz (01:15:30 -> 01:16:37)
you know, um right now we’re, we’re, we’re limited when we use, like the FDA doesn’t regulate, you know, pr P, but once you start adding things, then it becomes a drug and then it’s a completely different path to market. So, but, you know, within each one of us, you know, our platelets contain, contain 1000 different prote proteins. Like, you know, we have our own unique genetic code of healing peptides and proteins that you know, do the work in our bodies. And so the beauty of this is that it’s like a soup you’re putting in, you know, very rich concentration of platelets with, you know, we’re probably when we inject into a disk with our newer systems, we’re putting in 5 to 10 billion platelets, probably 50 to 100 million white blood cells in a two teaspoon aqua. So it’s very concentrated and it contains many things that we’re, we’re only beginning to understand which ones are the most important.
Dr. Lyon (01:16:39 -> 01:17:17)
Does the health of the individual make a difference of the outcome of the treatment? Meaning if an individual has a, we’ll just say diabetes. So if they have a, a blood sugar regulation issue, so that’s kind of one silo of an individual and then the other uh group of individuals, I would think if they have any kind of uh a cult infection or that was a cult, for example, Lyme, do you think that that diminishes the treatment? Should an individual try to address any kind of underlying illness prior to treatment, does that affect outcomes, clinical outcomes?
Gregory Lutz (01:17:18 -> 01:17:50)
I don’t think there’s any studies yet on that, but clinically, I think it’s 100% true, like the healthier you are the more powerful your healing cells are. And so, you know, you know, going on a low inflammatory diet, you know, seeing a functional medicine specialist to, to optimize your microbiome and, and to correct any nutritional deficiencies and to rule out, you know, any causes of chronic inflammation, like you said, of limes, those sorts of things is, is, is only gonna help the success of the procedure.
Dr. Lyon (01:17:51 -> 01:18:34)
That’s really interesting. I, I wanna take a moment to highlight the fact that you are a psychiatrist with multiple publications and also um a highly sought after clinician in some of the most esteemed places. And you mentioned functional medicine, which those two typically are very divergent. And I’m curious as to how you see that integrating and how you even came upon that. And I, I will mention one more thing why I think the listener or the viewer should follow you and learn from you is you’re an innovator and innovators always think outside the box.
Gregory Lutz (01:18:35 -> 01:19:37)
Well, I appreciate that. And, you know, I was introduced to functional medicine through my wife Paula who is a health coach. She’s a, you know, integrative health health coach. And so I would go to some of her conferences just to kind of tag along and, and that’s where I really, you know, uh that’s what piqued the interest. And so I’ve learned a lot from Paula and then also, you know, there are a lot of many good physicians in this space like yourself that are really promoting good science and, and also just getting the word out about a different way of managing health care. And I think, you know, regenerative medicine is one of the fastest emerging fields in medicine. But so is functional medicine. And I think the combination of functional medicine with regenerative treatments can solve so many problems, particularly in orthopedics and drugs or surgery
Dr. Lyon (01:19:38 -> 01:20:15)
in terms of, you know, you mentioned something, um you had mentioned earlier, the FDA has regulations about what you can and cannot do and how the treatment can be utilized. I think I was driving on one of the turnpikes here right outside New York City and I saw a billboard and it was advertising stem cell treatment and I’ve been to Florida, I’ve seen a lot of that as well. How does someone pick a provider? Uh How does someone vet an individual, what are the things that they should look for? And also why is this space at this time seeming a little bit like the wild wild west?
Gregory Lutz (01:20:15 -> 01:21:51)
No, it’s, it’s a good point. And, and actually, in my book, there’s a whole chapter about how to, how to um choose a reputable regenerative spine care physician and because there aren’t that many, first of all and, but, but it, if you go through the process of looking for, you know, board certification, good training, um you know, are they publishing their results? Are they contributing to the literature? Are they, are they talking at national conferences? You know, those are ways to do it. And I think like what the FDA allows us to do at least in 2023 is take your cells from you and put them, concentrate them with minimal manipulation and put them back into you the same day. Like that’s, that’s the guideline. If you go, if you go around that or beyond it, if you start adding things, then you’re, then you’re gonna be looking at, you know, a full FDA trial because that, that will be treated like a drug. So, so, so the FDA is definitely um cracking down on some of the, the wild West players in this industry. But it’s, it’s not unlike other industries that are young and new, there’s a learning curve and I think that it’s beginning to tighten and also as the data starts to build the good scientific data, I think, then it’s easier to, to choose the right provider. But but don’t be lured by advertisements and that’s usually not the best way to get medical care.
Dr. Lyon (01:21:51 -> 01:22:10)
And there’s some discussion about I V stem cell in augmentation. What are your, what are your thoughts on that? Is, is there a benefit. Is it dangerous? There’s also some discussion in the space about exomes. I would love to hear your take on some of those uh alternative treatments,
Gregory Lutz (01:22:10 -> 01:22:55)
right? And those are areas that the FDA is concerned about. Because again, if you take I V um therapy from umbilical cord stem cells, that’s a drug and that, that would have to go through a, a formal FDA process for to, to achieve a claim as a treatment. And to the best of my knowledge there, there’s nothing on the market yet that has gone through that process. So, and people who are going outside the country, you know, I would discourage that, you know, your, your own cells are made for you. They’re, they’re the safest. And I think that until um companies that are promoting that or providers that are promoting it, um go through the FDA process, I, I would stay away from it
Dr. Lyon (01:22:56 -> 01:23:37)
if you catch someone early with back pain. What percentage of individuals do you think will get a full resolution? And do you typically see injury in multiple discs? What, what is the length of time for healing? So for example, if someone is a highly athletic and they’re thinking, I have never heard of this microbiome in the spine. I’ve had chronic back pain. I went to my physician, they sent me over to orthopedics. They’ve told me there’s only two treatments available. Number one drug, number two surgery in terms of possibility of healing. Catching it early on. You said cure is that the typical outcome for people.
Gregory Lutz (01:23:38 -> 01:25:59)
You know, when we, when we first um did our first um double blind randomized control trial, our success rate was about 60% and success was divined by a statistically significant improvement in pain and function and pa patient was satisfied and, and just to put it in perspective, the control group only got 18%. So there was a a very big delta. So so but 60% is not good enough but to, to give more background, these were patients that were in pain on average for, for 4 to 5 years that nothing had worked and they were looking at a spinal fusion. And so we said, you know, and this was the, you know, using a, a first generation pr P system. And so what we said was, you know what we, we went back to the drawing board and said, well, if we can concentrate the platelets to higher levels, you know, would it yield a better outcome? So, so instead of directing 1 to 2 billion, what if we injected 5 to 10 billion? And that improves the success rate now to about over 80% you know, greater degree of pain relief and greater degree of um functional improvement. And then the last innovation we just made was we noticed that when we inject the cells to, to get it into the back of the disk is very hard with a straight needle technique. So we invented AAA catheter that’s made of a flexible metal called Ne Nyt. And now we can navigate a catheter directly in the back of the disk and, and cover all the painful tears with a very high concentration of PR P. And now we’re seeing really good results, structural healing and, and it’s that combination of therapy that we would like to do an FDA study on now and get a claim. So we, so we can get reimbursement so that this can be a standard of care treatment. So, so it’s a long journey to get something that’s a, you know, from bench to bedside and it, this has been 12 years and, but we’re almost there. And I think, you know, hopefully this year or next year, we’ll be able to start an FDA trial to get a claim. And so, but right now, I tell patients our success rate based on our last study is 81%.
Dr. Lyon (01:25:59 -> 01:26:32)
That’s incredible. And in terms of mechanism of action, when someone perhaps for providers that are listening to this there, it sounds like it’s a dual component. So number one, it’s impact on restructuring the microbiome within the disc. And number two, allowing for tissue healing with perhaps lower. Um I don’t know if the blood supply is lower, but uh regardless better tissue healing from the platelet ri rich plasma. Is there any other mechanism any other primary mechanism.
Gregory Lutz (01:26:34 -> 01:27:35)
You know, I, I, I think the way this, this works is that those proteins within the platelets, if, if you get them close enough to the periphery of the disc where the tears are, it, it stimulates a um cellular response to heal the tear because we, we actually have an MRI in the office. So we’ve part of our protocol is to do an MRI before the procedure, do the procedure and then reevaluate in 3 to 6 months to see if, if the not, not only is the patient better, but also is there any structural healing? And so, and what we’ve noticed is as we’ve gone up to higher concentrations of platelets and better delivery, the chance for healing has also gone up. And so the catheter was just approved last year. And so, you know, we’re still in the early stages of looking at that data, but qualitatively, the data looks very good with regards to the MRI.
Dr. Lyon (01:27:35 -> 01:27:49)
And who is this? Not for, for example, back pain caused by spinal stenosis? Are there other um issues that would not be appropriate for pr P treatment?
Gregory Lutz (01:27:51 -> 01:29:20)
It like if you look at back pain as a bucket, there’s 100 different causes. But by far, the most common is a problem with the disc, let’s say the disc represents 40 to 50% of chronic low back pain patients. But then as the disc degenerates, then the ligaments get thick, the joints get larger, the canal gets tighter as you mentioned, spinal stenosis. And then um you can also develop deformity like scoliosis or, or a slippage of the spine called spons thesis. And so this is really a treatment mainly for early stage dis disease. And you know, we we are trying to broaden the indications, but the data that we’ve published is really on early stage disc disease. People who have, you know, primarily degenerative disc that are still have 50% of their height. If it’s, if it’s flat, like a pancake, you’re not a candidate. If you have severe spinal stenosis, you’re not a candidate. If you have a large extruded disc, you’re not a candidate. You know, we do are we are exploring, you know, pr P epidurals instead of steroid epidurals, but we don’t have data on that yet. And you know, so I think that the role for stenosis patients for, for apr P epidural that might work better without the steroid load. But I think um the goal is to prevent the stenosis, prevent the degeneration. That’s why we want to get the word out
Dr. Lyon (01:29:20 -> 01:30:11)
and someone would be able to prevent it by getting it early, getting treatment, having imaging done. And I know that there is a financial barrier because again, you are working on being able to present the data to get these things covered, which often takes time. You know, we, you’ve been working on this for 12 or so years, which in medical science is actually not that long. It’s a, it’s a newer uh understanding these things and it’s, it’s evolving. But, uh you know, we send people all the time to get evaluated to get PR P and we’ve seen tremendous outcomes. The key is getting it early and not waiting. Um And then, and then also if an individual has had surgery, would they also be APR P candidate? So, uh what percentage of back surgeries fail in terms of uh pain?
Gregory Lutz (01:30:13 -> 01:31:40)
I think, you know, it depends on the type of surgery, you know, but I think in general, like the most successful type of spine surgery is just a simple micro diskectomy where they take the extruded disc out and, and they, you know, they, that’s usually like an overnight or same day surgery and, but there’s still that usually relieves the leg pain, but it doesn’t do much to keep the disc healthy. And so we have treated a number of patients after dissect toy with intradiscal PR P to relieve their back pain. And then in patients with spinal fusions, you know, over time, the disc above the fusion or below the fusion starts to break down. So we’re using PRP to, to try to keep those, those segments healthy. And I think so those are the types of patients that we treat after surgery. But from a standpoint of the success rate of a spinal fusion, I think it’s a 50 50 you know, and I think that that’s something that, you know, that isn’t really a root cause treatment for a degenerative disc. If we think that the, the, the process is a unhealed wound inside the disc that has bacteria, then a spinal fusion is not the right treatment. And I think that’s what we’re trying to do is educate people that, you know, and shift the paradigm based on a root cause treatment, which is something that is similar or analogous to intradiscal pr P.
Dr. Lyon (01:31:40 -> 01:32:01)
Do you believe that the overarching cause of some of these issues? You know, I say some because obviously there’s things outside, you know, structural or, or otherwise is the microbiome. Do you think if you were to say the number one cause of back pain is microbiome related?
Gregory Lutz (01:32:01 -> 01:33:21)
I I don’t think we’re there yet. We don’t know enough, but I, I think the microbiome definitely plays a role and I think, you know, like the types of patients I see um a lot of them get injured in the weight room. Like I really, you know, like they, they start getting stronger, their form, you know, dead lifts are like great for my business. Like I see a lot of dead lifting injuries. I see a lot of power squat injuries. And then, you know, even with young um you know, adolescents, you know, that are, they’re working with strength strength coaches and they think they got injured in their lacrosse game, but actually their injury, you look at their MRI they have two degenerative discs that’s not from lacrosse, that’s from dead lifts and, and overdo it in the weight room and tearing the disc with excessive load. And so I think, I think the role the bacteria plays is when the dis tears, the body may be bringing in some abnormal bacteria. And I think that has a role. So, so I, I, you know, I don’t think we fully understand, I I can’t say the microbiome is the number one cause. Um because I think a lot of it is is injury, you know, they’re, they’re injured from motor vehicle accidents, falls sports and the disc tears and it just never
Dr. Lyon (01:33:21 -> 01:33:31)
heals and, and part of the reason that the disc never heals may be related to this insult in the microbiome or the the bacteria.
Gregory Lutz (01:33:31 -> 01:33:55)
Very possible, very possible. But I think, I think it, it also explains why some patients have more severe pain, but the MRI looks very similar. And I think it’s, I think that’s where the bacteria play a role because bacteria cause severe inflammation, severe inflammation, sensitizes nerves and makes those discs more painful.
Dr. Lyon (01:33:57 -> 01:34:18)
That’s, that’s so fascinating in terms of uh treatment cadence. Would someone come in? Obviously? Um this varies depending on the injury and what uh you know, how many discs need to be treated? Does someone come in for one treatment of say two or three discs and then wait six weeks and then come in for another, what is the cadence of treatment?Gregory Lutz (01:34:19 -> 01:34:35)
You know, we, we actually have published a study uh with 5 to 9 year outcome of patients and 71% had long term relief with a single procedure. So we’re not repeating this.
Dr. Lyon (01:34:35 -> 01:34:37)
That’s incredible. That’s incredible.
Gregory Lutz (01:34:37 -> 01:35:37)
And the only reason like we can treat multiple levels, that’s not an issue. Um You know, we most commonly we’re treating probably two levels. But some, sometimes we, we if the discs look bad and the patient has pain, you know, we will treat more than uh one level. And I think what, what we typically do is give it 3 to 6 months because some people, most people will feel improvement in the first 4 to 8 weeks, but that improvement continues for up to six months. So I say just give it six months, work on your rehab, get stronger. And then I would say we, we would repeat it only if the patient had good relief, but it was partial. If they get no relief, I I wouldn’t repeat it. And, but if they get, you know, 50% and they want more, then you know, it, it there’s no harm in doing a booster injection. And I think that what we see with that is further improvement.
Dr. Lyon (01:35:38 -> 01:35:53)
So, and then how long after do, can they be physically active again? Or do you recommend that they never go back to their, the loads unless their mechanics are perfect. What is the uh subsequent outcome in terms of activity?
Gregory Lutz (01:35:54 -> 01:36:24)
You know, I I really use that structural healing timeline. Like if, if, you know, collagen takes 4 to 6 weeks to mature. And so during that first 3 to 4 weeks, I say walk and swim and heal and just give, you know, you’ve been in pain for years, let’s try to give it a chance to heal. And then for that second, four weeks, they go into a kind of a poor stabilization program and then after that, they can start to return to their sports,
Dr. Lyon (01:36:25 -> 01:37:11)
you know. Um and your book is so interesting, there is uh a section there on the microbiome and these disc injuries and healing. I I recommend everybody and, and I’ll link to your book. Um So it’s just so interesting uh very innovative in terms of oral intake of any kind of prebiotic or anything. Have you thought about ways in which potentially could move the needle prior to injury? So if you were to say, um you know that you’re training and you’re working out really hard add in sacrifices, Belardi or there’s the potential to perhaps this pro or probiotic may impact the gut microbiome and balance out the negative.
Gregory Lutz (01:37:12 -> 01:38:23)
You know, I think if, if they have a abnormality, it should be corrected prior to the procedure. Like, you know, if there was something that their functional medicine physician picked up that, that would, that would increase their inflammatory response and lower their absorption of nutrients then correct it. And I think um some of the other supplements, like, I think, you know, vitamin C is great for, you know, collagen healing. There’s some scientific data to support the use of Melatonin um as a stimulator of dis chealing. And so that’s something that you, you could take, you know, five mg at night. You know, it’s just helps you sleep better. And, and so, and then, you know, collagen protein, if you’re having absorption issues and you’re having um you know, having enough protein in your diet, I think those are all important things for healing. And I think we, we, we need to learn more about how to optimize the micro, you know, the gut disk access. That’s something that is really that area of medicine is in its infancy. And I think with a I, we’ll learn a great deal more in the years to come.
Dr. Lyon (01:38:23 -> 01:38:26)
How do you think A I will do? It’ll just help with the uh algorithms.
Gregory Lutz (01:38:27 -> 01:39:10)
Yes and screen, you know, screening what’s important, what’s not important or what’s, what’s, what’s an abnormal overgrowth. It’s actually a very interesting article and I think it was, it was from China that showed an idiopathic scoliosis. They looked at the gut microbiome and there was an overgrowth of a very particular bacteria that was associated with scoliosis. So, so the these things are starting to come out. And that was a first for me. I never heard that before. And so I think that, you know, we’re gonna keep, continue to learn but we do know that, you know, you know, c acnes or cut bacterium acnes, you know, is a major player with this degeneration.
Dr. Lyon (01:39:11 -> 01:39:16)
And is there an antibiotic that would treat, that would, would help re reset the gut microbiome?
Gregory Lutz (01:39:16 -> 01:39:52)
There is. But I think the problem, there’s a study where they, they put patients on antibiotics for 100 days and, and you know, but to treat back pain with 100 days of antibiotics, I think isn’t good antibiotic stewardship because, you know, there’s 580 million people in the world with, with back pain. Can you imagine putting them on that much antibiotic for 100 days? And you know, so the, and the data on it was refuted. But, you know, but I think there is uh I think doing something in the local environment with the leucocyte rich pr P is more appropriate.
Dr. Lyon (01:39:52 -> 01:39:58)
That is amazing. That is amazing. And you’re a practicing clinician. How many days a week are you in? Clinic?
Gregory Lutz (01:40:00 -> 01:40:01)
I’m usually in clinic three days a week
Dr. Lyon (01:40:02 -> 01:40:08)
and the majority of your patients are they overall young healthy men? Do you see a wide spectrum?
Gregory Lutz (01:40:08 -> 01:40:22)
I see wide spectrum, you know, and I like, I like to see, you know, any muscular skeletal condition. Um But I, my research is partic, particularly involved in the spine and more specifically in the disc.
Dr. Lyon (01:40:22 -> 01:40:43)
Should someone, do you recommend people, let’s say, for example, they’re highly active but not in pain. Would you recommend a highly active person not in pain who is enjoying doing these lifting, you know, whatever lifting that they’re doing come in for potential screening to catch it really, really early or would, would that be uh not a clinical indication?
Gregory Lutz (01:40:44 -> 01:41:08)
No, we see patients who really, you know, they, they have friends with severe back pain or, or they have a loved one that has had severe back pain and there is really very little harm in getting an MRI, there’s no radiation exposure. And I think that it’s a, it’s a nice way to screen and, and it gives you an idea of, ok, well, you know, you have really good disc tissue or you don’t. So I think, you know, there’s nothing wrong with screening
Dr. Lyon (01:41:08 -> 01:41:12)
and no, there are no overt contra indications for this procedure.
Gregory Lutz (01:41:13 -> 01:41:33)
The, the main thing is, you know, if your plate account is, is low, then that would be a contra indication for whatever reason. And so, you know, but if your plate account is over 100,000, then you’re a candidate for the and you haven’t, you have a history, an exam and an MRI that are all consistent with a disc uh problem. Then you are kidding.
Dr. Lyon (01:41:33 -> 01:42:08)
Would you ever say if someone has an HSERP that you would want to see or, or said rate, would you want to see these inflammatory markers lower prior to doing it just for better outcomes? Would you say? OK, your set rate is over 30 and your HSERP is, I don’t know, 10, you don’t have a ton of co morbidities but you are struggling with obesity or X Y and Z which is driving this up, would you say, go see my wife spend two months or three months lowering your inflammatory markers and then we’re gonna hit your procedure.
Gregory Lutz (01:42:10 -> 01:42:52)
Yes, we actually check all that before procedure just to make sure. And, and I check it for two reasons. I check it for the reason you mentioned. But then I also, I want to know where the patient is on the remote chance that they were developing an infection. At least I know where they’re starting from. And because there are patients that have, you know, no systemic signs of an infection, but then their MRI showed shows shows certain changes that might be suggestive of an infection. And those are the patients we want to monitor very closely. So we do get set rates and C R P S on them just as a baseline prior to the procedure, including, you know, a plate account as well.
Dr. Lyon (01:42:53 -> 01:42:58)
What would be the signs of an infection versus an overt structural change on an MRI?
Gregory Lutz (01:43:00 -> 01:44:10)
So on the MRI, you, you know, there, there are changes, um called modic changes and modic changes. We used to think they were just inflammatory responses. But when you, there’s studies now that show if you biopsy those areas on the, on the MRI that have the modic changes, there’s a, there’s a 30 40% growth of sea acne. And so I think that’s one chain, one change that we look for. And it’s usually very pathetic of a symptomatic level. And what you see on the MRI is you see increased signal on certain spin sequences and decreased signal in the end plate of the vertigo body where it meets the disc. But then there are other changes you can see um on the disc itself if we think it’s a uh if it’s not, if it’s a discitis, you know, and certainly we wouldn’t cheat, uh treat A and AAA systemic spinal infection with PR P. But we may be treating occult infections with PRP. Um because of this issue of the overgrowth,
Dr. Lyon (01:44:10 -> 01:44:21)
it’s fascinating if you were to say, what are the top three things that someone would need to execute for spinal health? What would they be?
Gregory Lutz (01:44:22 -> 01:45:27)
I think sleep is really important for recovery. I think, you know, minimize your sitting because, you know, we sit to way too much and the disc receives its nutrition through compression, relaxation and not just chronic compression. And then I think from a standpoint of um you know, this issue of global obesity lower your, your B M, I, you know, lower the stress to your spine. I think that’s really important and then, you know, exercise is so important but it has to be the right kind of exercise. And I think that there are certain exercises in the weight room. I, you know, I’d love to work out, you know, with weights and I’ve done it all my life but there’s certain things that I avoid just specifically to avoid injuring my disk and the, and the ones I see the most commonly in the office are dead lifting. Power squats are the two and even leg press because, you know, your legs get so strong that the load that it, they can handle that it creates on the spine becomes, you know, excessive.
Dr. Lyon (01:45:29 -> 01:46:06)
I think that that’s all so valuable. And if you are having pain, which again, there’s millions and millions of people with back pain, treat it early. Don’t wait. There are other options other than surgical and really heavy medications and also steroid injections which over time uh are, are not the best, not the best course of treatment. So, well, Dr. Lutz Thank you so much for coming on. I’m gonna link all this information, uh, your book. Uh Where else can people and I, you know, your website, where else can people find you?
Gregory Lutz (01:46:07 -> 01:46:32)
Uh They could find me at, um, you know, Regenerative Sports Care Institute in New York City. It’s, um, our private regenerative medicine clinic and it’s on the 88th in between Park and Madison. That’s, that’s our home. And thanks so much for having me. I really enjoyed our conversation and I hope the listeners have learned something new because I, I certainly have over the past few years.
Dr. Lyon (01:46:32 -> 01:46:42)
Guaranteed, guaranteed that people are going to learn something that they’ve never heard before. I know that your time is precious. I’m so grateful. Thank you so much.
Gregory Lutz (01:46:43 -> 01:46:44)
Thanks for having me.