A Patient’s Path Back to an Active Life
Dr. Ilana Etelzon of Pain Doctors Medical shares a case that reflects what she sees often in her practice: a patient who had tried nearly everything before finding her way to regenerative medicine.
A 55-year-old woman presented to our office with chronic lower back pain radiating into both legs. She had been struggling with persistent symptoms for several years despite extensive conservative treatment, including physical therapy, physician-directed home exercises, activity modification, anti-inflammatory medications, and multiple epidural steroid injections. Although the injections provided only temporary relief, her pain consistently returned, limiting her quality of life.
The patient reported significant difficulty performing everyday activities such as cooking, grocery shopping, hiking, traveling, and caring for her family. She wished to avoid additional steroid injections and was reluctant to undergo spine surgery.
After a comprehensive evaluation, including a detailed physical examination and review of her imaging studies, she was determined to be an appropriate candidate for a minimally invasive regenerative treatment designed to address the underlying source of her pain rather than simply mask the symptoms.
Over the weeks following treatment, she experienced progressive improvement in both her lower back pain and the pain radiating into her legs. As her recovery continued, she was able to return to the activities she enjoyed most, including cooking, hiking, traveling, and caring for her family without significant limitations. She no longer required pain medications, additional physical therapy, or further steroid injections.
Most importantly, she was able to avoid spine surgery while regaining an active lifestyle and a substantially improved quality of life. She expressed tremendous satisfaction with her outcome and was grateful to return to living life on her own terms.
The treatment behind this recovery is a bone marrow concentrate injection, often called BMAC. The procedure draws a small sample of the patient’s own bone marrow, concentrates the cells and growth factors within it, and delivers that concentrate directly to the site of injury using image guidance. For patients who want to avoid spine surgery and long term reliance on steroid injections, it offers an option that targets the source of the pain instead of covering it up.
The Pain Doctors Medical Approach to BMAC
Dr. Etelzon is a Regenexx Certified Core Provider, a distinction that shapes how her practice performs bone marrow concentrate injections from start to finish.
One of the biggest differences in our approach is that we don’t simply perform a bone marrow concentrate (BMAC) injection. We follow a comprehensive, evidence-informed protocol designed to maximize precision and optimize the biologic environment for healing.
As a Regenexx Core Provider, I have undergone extensive advanced training in image-guided orthobiologic procedures and follow standardized protocols developed through years of clinical experience and ongoing research. Every patient undergoes a thorough evaluation to determine whether regenerative treatment is appropriate and to identify the specific structures responsible for their pain. Careful patient selection is one of the most important factors in achieving successful outcomes.
Our procedures are performed using high-resolution ultrasound and fluoroscopic guidance to ensure accurate placement of the biologic into the intended target tissues. Rather than treating only a single painful area, we frequently evaluate and address all of the structures contributing to dysfunction, including joints, ligaments, tendons, muscles, and, when appropriate, the spine, creating a comprehensive treatment plan tailored to the individual patient.
Another key difference is our attention to biologic preparation and rehabilitation. Bone marrow concentrate is processed according to established protocols, and treatment is often complemented by platelet-rich plasma (PRP), platelet lysate, or platelet-poor plasma (PPP) when clinically indicated. Patients also receive individualized rehabilitation guidance, activity modification, and follow-up to support recovery and optimize long-term function.
Being a Regenexx Core Provider does not guarantee a particular outcome, and no regenerative treatment is effective for every patient. However, it does mean that patients are treated using standardized protocols, advanced image-guided techniques, rigorous training standards, and an evidence-informed approach that emphasizes precision, safety, and appropriate patient selection. These principles are designed to give patients the best opportunity for a successful outcome while helping many avoid or delay more invasive procedures when clinically appropriate.
When Surgery Is Still the Right Path
Regenerative treatment is not the answer for every patient, and Dr. Etelzon is candid about where its limits are and how she determines the right course for each person she sees.
One of the most important conversations I have with every patient is understanding that regenerative medicine is incredibly powerful, but it is not the right solution for everyone. My responsibility is not simply to perform a procedure: it’s to determine whether that procedure gives the patient a realistic chance of avoiding surgery.
There are situations where regenerative treatment alone is unlikely to provide the desired outcome. Patients with progressive neurologic weakness, significant spinal instability, severe deformity, advanced joint destruction, certain complete tendon ruptures, infections, fractures requiring stabilization, or conditions such as cauda equina syndrome often require prompt surgical evaluation. In these cases, delaying surgery could actually worsen the outcome.
The key is determining why the patient has pain. I spend considerable time reviewing imaging, performing a comprehensive physical examination, and correlating the two. I want to identify the true pain generators, not just the abnormalities seen on an MRI. Many patients are told they need surgery based solely on imaging, yet their symptoms may actually arise from treatable ligaments, tendons, joints, muscles, or other structures that have never been properly evaluated.
When appropriate, we take a comprehensive, precision-based approach. Rather than focusing on a single painful spot, we evaluate the entire functional unit and address all of the structures contributing to the patient’s symptoms. That may include treating joints, supporting ligaments, tendons, muscles, and other stabilizing tissues using advanced image-guided regenerative techniques, combined with individualized rehabilitation, activity modification, and ongoing follow-up. The goal is not simply pain relief, it is restoring function and improving the body’s ability to heal.
Only after I am confident that we have appropriately evaluated the patient and determined whether a regenerative approach is likely to help do we discuss treatment. If I believe surgery offers the best chance for recovery, I will tell my patient that honestly and refer them to an appropriate surgeon. My priority has always been doing what is best for the patient, even when that means recommending against a procedure in my own office.
For many carefully selected patients, regenerative medicine can help reduce pain, improve function, and potentially delay or avoid surgery. However, the best outcomes come from proper diagnosis, meticulous patient selection, precise image-guided treatment, and knowing when regenerative medicine has reached its limits. That commitment to individualized care is what allows us to confidently pursue every reasonable option before recommending surgery while never compromising patient safety.
Finding Out If You’re a Candidate
Pain Doctors Medical evaluates candidates for bone marrow concentrate injections and other regenerative treatments at its Brooklyn, Clifton, Newark, and Perth Amboy locations. A consultation with Dr. Etelzon includes a review of imaging, a physical examination, and an honest conversation about whether regenerative medicine is the right next step, or whether a surgical referral makes more sense.
Schedule a consultation to find out which path fits your situation.