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Dr. Spain explains non-operative treatment using patient’s bone marrow

Photo credit: Gulf Coast News Today

Dr. J. Keith Spain discusses an innovative non-surgical procedure that uses stem cells in a patient’s own bone marrow to prolong surgeries such as knee replacements. “We’re not looking to replace surgery, but oftentimes this procedure can work in conjunction with surgery to help in the healing process, or to put off the surgical process when necessary.”
Thank you Gulf Coast Media for helping us educate our community about these innovative technologies available at The Orthopaedic Group, P.C.

Below is an excerpt from the article in Gulf Coast News Today or you can view the article here.


FOLEY — There was a time when, for those dealing with a sports injury or arthritic pain, their only option was an invasive surgical procedure with an often painful recovery. For many, surgery is still the only option, but for others, replacement therapies such as platelet-rich plasma (PRP) and bone marrow aspirate (BMA) are becoming increasingly common.

“We believe that bio-orthopedics is definitely the future of the industry,” said Dr. James Keith Spain with The Orthopaedic Group. “We’re not looking to replace surgery, but oftentimes this procedures can work in conjunction with surgery to help in the healing process, or to put off the surgical process when necessary.”

A native of Mobile, Spain received his undergraduate degree from Tulane University before returning to Mobile to receive his medical degree from the University of South Alabama. After completing his residency in Florida with a fellowship in sports medicine, Spain practiced for two years in Naples, Florida, before being hired by The Orthopaedic Group – a group of 30 surgeons who operate offices in Mobile and Foley – about a year ago. “I was brought in specifically to perform non-surgical procedures,” Spain said.

Orthoscopic surgery usually lasts about 20 years, after which a reconstructive surgery will have to be performed, Spain said. “If you are a man or a woman in your 50s, surgery would mean you will likely need another surgery in your 70s,” he said. “We also see older patients who don’t necessarily need a procedure that would last 20 years.”

A non-invasive procedure known as platelet-rich plasma (PRP) has been traditionally performed on patients who don’t want or need invasive surgery, Spain said. Using a special machine, the blood is separated and concentrated into its basic components, white blood cells, red blood cells, platelet-poor cells and platelet-rich cells. The platelet-rich cells are then taken and injected into the injured area. The concentration of platelets in PRP allows your body to recognize the injury as a priority and heals it more quickly and more thoroughly than your body can by itself. The main drawback to the procedure is that the effects only last about six months.

Spain studied with a group of surgeons at the Blue Tail Medical Group in St. Louis, Missouri, on a new procedure called bone marrow aspirate (BMA). The procedure works similar to PRP using bone marrow stem cells, taken generally from the hip area. The stem cells are concentrated using a special device much like a centrifuge which separates out the cells and using ultrasound technology, doctors can work directly at the site of the injury or degenerative tissue to increase the healing potential. Results last up to 5 years as opposed to six months with PRP therapy, Spain said. “This is basically PRP therapy taken to the next level,” Spain said.

Now, instead of having surgery at age 50, the BMA therapy can put that off for up to five years. If a second procedure is done, that will push it back to 10 years. “Now you’re looking at a 60-year-old patient,” he said. “The chances that the procedure could take the patient through the rest of his active life increases exponentially.”

Patients from all over the country come to the St. Louis clinic for the procedure. The three doctors at the clinic perform about 1,000 procedures a year. “In fact, when I was there studying, a man called from Robertsdale about coming to St. Louis for the procedure,” he said. “I thought, ‘why is it necessary for patients to go to Birmingham, Atlanta or even St. Louis when we can do these procedures here in Baldwin County.’ This area is growing and there is definitely a need here.” The number of patients he’s seen has definitely been on the rise over the last year, Spain said. “I’ve seen as many as six patients in a week,” he said.

Another procedure, Spain said, is known as ADSC/fat graft, where fat tissue is removed from an area of the body where it is stored easily. Stem cells are taken from that and used as a matrix and become the scaffolding for the platelets or bone marrow stem cells to adhere to and activate healing. “Stem cells decrease over time, so in older patients, it becomes harder to find the stem cells needed to perform the procedure,” he said. “Using fat cells means there is a higher concentration and more likelihood of finding the stem cells needed. We are not taking stem cells away from them. They will still regenerate. There just aren’t as many of them.”

While procedures are most often performed on the knee, they can also be applied to the shoulders, hips and ankle areas. Oftentimes, Spain said, he has to overcome the stigma of using a stem cell procedure with patients. “A lot of patients hear stem cell and think of embryotic stem cells, but that is not the case here,” he said. “This procedure uses your body’s own stem cells so there is very little likelihood that your body is going to reject something that actually came from itself.”

Another concern with patients is that the procedures are considered investigational and are not covered by insurance, Spain said, but for many patients, the cost is not much more than, in some cases less, than their insurance co-pay would be. You can find out more about stem cell and other regenerative procedures at or call Spain at The Orthopaedic Group, (251) 450-2746.

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