FSU & BACK PAIN
“How Is My Back Pain Related to the Florida State University (FSU) Seminoles?”
No, your back pain doesn’t have anything to do with Florida State University. However, regardless of your collegiate affiliations, if you have chronic back pain you may want to consider treatment at your “FSU”. In this particular instance, FSU stands for “Functional Spinal Unit”, and not the college.
So, what exactly is the functional spinal unit (FSU)?
Simply put, the FSU is a combination of all of the spinal muscles, ligaments, cartilage, and nerves that keep the spine together, and functioning normally. Generally, the structures in the FSU consist of:
• Facet joints and capsules
• Iliolumbar ligaments (superior and inferior bands)
• Interspinous ligaments
• Supraspinous ligaments
• Ligamentum flavum
• Intervertebral discs
• Anterior and posterior longitudinal ligaments
• Spinal nerve roots and their branches
• Multifidus muscles (technically these are not part of the functional spinal unit however play a major role in spine stabilization).
When one or more structures in the FSU becomes damaged or degenerated, it often leads to a cascade of events resulting in a chronic pain condition. Ligaments and joints can become inflamed and actually start causing pressure on nerve roots. Ligaments can also become weakened and “lax”, allowing for increased (abnormal) movement between spinal segments. This can lead to nerve root irritation. If nerve roots become inflamed then the muscles that those nerves supply become dysfunctional and weak. Weakened muscles (especially in the lower extremities) can lead to poor posture and even damaged joints.
How can the FSU be treated?
• If you have chronic back pain, you have probably heard the term “core strengthening” over and over again.
• You have also probably heard how important it is to make sure that you are not carrying extra weight in the abdomen, as this puts a tremendous amount of added pressure on the FSU. (Interestingly, because of the physics involved, 1 extra pound of weight in the abdomen results in a 3-pound detrimental force at the FSU!)
• So yes, while it is true that you need to strengthen your core and maintain as healthy a BMI (body mass index) as possible it is also true that even when these factors are optimized you may still have pain. Additionally, sometimes the pain can be so bad that it prevents you from achieving the goals of core strengthening and weight reduction!
This is where treatment at the FSU with Biologics can come in. By “Biologics” we are typically referring to patient-derived products such as:
• Platelet rich plasma (PRP)
• Platelet poor plasma (PPP)
• Platelet lysate (PL)
• Growth factor concentrate (GFC)
• Alpha -2-macroglobulin (A2M)
• Interleukin-1 receptor activating protein (IRAP)
• Bone marrow aspirate concentrate (BMAC, or “stem cells”)
Once the patient has been identified to be a candidate for treatment at the FSU, appropriate targets (as listed above) and appropriate combinations and concentrations of Biologics (as listed above) are identified during a planning visit. Next, the procedure is carried out in one setting, on an outpatient basis, during a 45-minute procedure. Since all of the target areas in the functional spinal unit are located in very precise locations, it is important that some form of image guidance is used when considering treatment at the FSU. Typically, live fluoroscopic guidance is the best and safest way to verify that the Biologics are being placed at the best possible locations in and around the spine. It is not uncommon for a person to have 8–10 injections on each side of the spine during and FSU treatment. Thankfully the needles are very small; in some cases, as small as an acupuncture needle!
What can I expect after treatment at the FSU?
We typically tell patients to plan on some “down time” after treatment at the FSU. The rationale for injecting Biologics at the FSU is so that they can help the body to “heal itself” over time. This may result in reduction of inflammation, and shrinking of inflamed tissue. In some cases, ligaments may also be strengthened by injection of Biologics, and atrophied muscles may benefit from injection of growth factor–containing Biologics. If these outcomes are achieved, the theory is that the spine may become more stable over time — hereby improving pain and normalizing function. These changes take time, and do not happen overnight. In fact, most patients may not note any “sudden changes” at all, but instead notice that their activity tolerance level and general comfort level improves gradually over the course of weeks to months after treatment at the FSU.
How long does the benefit from the treatment last?
As with any medical procedure, outcomes are variable and guarantees should not be offered with regard to outcome more durability of this procedure. Additionally, this treatment protocol is considered “cutting-edge” and therefore, by definition we do not have years and years of clinical outcome data at this point in time. However, all of our patients undergoing this procedure will be entered (with their permission) into the Interventional Orthopedics Foundation patient registry database so that outcome data can be tracked proactively over time.
If the patient feels that they have received benefit from treatment with Biologics at the FSU, the procedure can be repeated as needed. Typically, we wait for 3-4 months after a Biologics procedure before deciding on additional treatment.
