Intramuscular autologous bone marrow cell therapy, with preparation of harvested cells, multiple injections, one leg, including ultrasound guidance, if performed; complete procedure including unilateral or bilateral bone marrow harvest
CPT4 code
Name of the Procedure:
Intramuscular Autologous Bone Marrow Cell Therapy
Summary
Intramuscular autologous bone marrow cell therapy involves extracting bone marrow cells from your own body, preparing these cells, and then injecting them into the muscles of your leg. The procedure is guided by ultrasound to ensure precision and can include harvesting bone marrow from one or both sides of the pelvis.
Purpose
This procedure aims to promote healing and regeneration in muscles that have been damaged or are not functioning correctly due to conditions like chronic ischemia. The goal is to enhance muscle function and reduce symptoms such as pain and weakness by using your body's own regenerative cells.
Indications
- Chronic limb ischemia.
- Peripheral artery disease.
- Muscular dystrophy.
- Poor wound healing in the leg.
Candidates usually include patients who have not responded well to more conservative treatments.
Preparation
- Fasting may be required for a specific duration before the procedure.
- Certain medications, especially blood thinners, may need to be adjusted or discontinued.
- Pre-procedure assessments will likely involve blood tests and imaging studies to evaluate the condition of your bones and muscles.
Procedure Description
- Bone Marrow Harvesting: Bone marrow is typically harvested from the pelvic bone under local anesthesia or sedation.
- Cell Preparation: The collected bone marrow is processed in a lab to concentrate the stem cells.
- Injection: The prepared cells are then injected into the leg muscles using ultrasound guidance to ensure accurate placement.
Equipment used includes syringes, needles, ultrasound machines, and cell processing systems.
Duration
The complete procedure generally takes 2 to 4 hours.
Setting
The procedure is performed in a hospital or surgical center equipped with ultrasound and laboratory facilities.
Personnel
- Orthopedic or vascular surgeon
- Radiologist (for ultrasound guidance)
- Nurses
- Anesthesiologist, if sedation or general anesthesia is used
Risks and Complications
- Infection at the injection or harvest site.
- Pain or discomfort at the harvest or injection sites.
- Bleeding or hematoma formation.
- Adverse reactions to anesthesia.
- Incomplete or insufficient therapeutic outcome.
Benefits
- Potential for improved muscle function and reduced pain.
- Utilizes the patient's own cells, minimizing the risk of rejection or allergic reactions.
- Could delay or prevent the need for more invasive treatments like surgery.
Recovery
- Monitoring immediately after the procedure to assess for any immediate complications.
- Instructions on wound care and activity restrictions.
- Pain management strategies including medications and rest.
- Periodic follow-up appointments to monitor progress and efficacy.
Recovery time varies but generally involves several weeks, with noticeable improvements in muscle function potentially occurring within months.
Alternatives
- Pharmacological treatments (e.g., medications to improve blood flow).
- Physical therapy and exercise.
- Surgical interventions like vascular bypass or angioplasty.
- Stem cell therapy from other sources (e.g., adipose tissue).
Each alternative has its pros and cons, such as varying degrees of invasiveness, recovery times, and success rates.
Patient Experience
- During the procedure, patients may experience some discomfort during bone marrow harvesting but will be under anesthesia or sedation to minimize pain.
- Post-procedure soreness is common at both the harvest and injection sites.
- Pain management will be provided, and patients are encouraged to rest and follow care instructions to facilitate recovery.