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|Bone Marrow Aspiration versus Lipoaspiration
(Liposuction) Adipose Tissue Stem Cells
|Some things to consider when deciding between liposuction versus bone marrow aspirate
for obtaining stem cells.
To date, there are no randomized, clinical controlled studies comparing liposuction
derived stem cell therapy versus bone marrow aspirate stem cell therapy for any
musculoskeletal disease or injury.
When deciding between the two elective procedures then one must consider the
procedures and the risks.
Adipose Derived Stem Cells:
Adipose tissue is obtained via liposuction or lipoaspiration. A tumescent liposuction is
performed by injecting a large solution of saline, lidocaine, and epinephrine (1 to 3 liters)
into the subcutaneous fat layer of your abdomen or buttock to make the fat swollen and
firm (tumescent) and then after a 30 minutes of percolating, a cannula is inserted and with
slow to and fro motion (think of carving a turkey or playing the violin) the fat is damaged
and sucked out.
The lipoaspirate then has to be processed to obtain the stem cells, which can be
processed mechanically (think of making butter with marbles) or enzymatically via
digestion and addition of chemicals. Reference link.
Here is one depiction of a mechanical method at Research Gate:
Here is a depiction of an enzymatic process, Bio-Protocol, visit link to see the list of 29
reagents and materials and the 27 steps involved. You do not want any of these reagents
in your body as they are harmful and not studied for human use.
Cell yields from mechanical methods are contaminated, highly variable, and extremely
low in nucleated cell counts, with counts as low as 10,000 to 240,000 per ml. This is the
method used by New York and other New Jersey regenerative institutes as enzymatically
processing adipose tissue for stem cell use is illegal in the U.S.
It is illegal because the addition of chemicals to your adipose tissue make your fat a drug
and drugs have to be rigorously studied and regulated to make sure they are safe for
human use. And those chemicals used to process your fat, that eat away your fat, that
are toxic if touched by your skin, will be injected back into your tendons and joints
without oversight or testing. To bypass this problem, companies have come up with
mechanical methods of separating out your stem cells from your fat but these methods
are highly variable, inefficient, and produce fat fluid that are low in stem cell counts and
highly contaminated. These are the methods you are paying thousands of dollars for in
other regenerative institutes.
Compare these numbers to Dr. Silberman's method which yields an average of 37 million
nucleated cells per ml from bone marrow aspirate, with the addition of no additives,
chemicals, or enzymes. Reference link.
What are the risks of liposuction?
Complications of liposuction include disfiguration, infection including deadly necrotizing
fasciitis, abdominal wall injury, bowel herniation, bowel perforation, bleeding, hematoma,
seroma, lymphedema, pulmonary embolism, deep vein thrombosis, lidocaine toxicity and
cardiac events, and pulmonary edema. Reference link.
The mortality rate of liposuction performed by cosmetic surgeons is estimated to be 1 out
of 5224 procedures, or an estimated 20 out of 100,000 procedures. The fatality rate of
U.S. motor vehicle accidents is 16.4 deaths per 100,000 motor vehicle accidents.
In another study, a 21.7% minor complication rate and a .38% major complication rate
are reported. Minor complications include palpable and visible permanent deformity,
seromas (fluid collections), hyperpigmentation of the skin, cutaneous slough, and
Bone Marrow Aspiration Derived Stem Cells:
Bone marrow aspiration using a marrow cellution needle that Dr. Silberman uses involves
numbing the iliac bone, insertion of the needle, removal of 10cc of bone marrow aspirate,
5cc for one joint, and then injecting the bone marrow aspirate directly back into the
injured or diseased location. Direct from your body, back in to you body.
Are bone marrow aspirations painful? Perception of pain is different for everybody but
for most, as we collect more data, pain appears to be at its worst a level of 4 out of 10
while for some it is a 1 of 10.
Bone marrow aspirations are not painful. I repeat bone marrow aspirations are not
painful. If a bone marrow aspiration is painful it is usually due to one of the following:
insufficient amount of local anesthetic, incorrect placement of local anesthetic, and
incorrect placement of the bone marrow needle in a site on the bone NOT anesthetized.
If the correct amount of anesthetic is used, usually 10cc of lidocaine directed and
infiltrated along the lining of the iliac crest, and the bone marrow needle is placed in the
same location as where the local anesthetic was directed, one would expect to
experience mild discomfort to no pain at all, which is the experience of the author’s
patients. We are currently publishing our data.
What are the risks of bone marrow aspiration?
In a study of 19,259 bone marrow procedures (13,147 bone marrow aspirations plus a
bone marrow biopsy, which are NOT done for musculoskeletal stem cell procedures,
and 6,112 bone marrow aspirations alone), 16 adverse events occurred, representing a
rate of 0.08% of all procedures. Bleeding occurred in 11, infection in 2, persistent pain
in 2, and a serous leak in 1 who suffered from cancer and kidney disease. Out of the 11
who had bleeding, 10 of them had one or more risk factors for bleeding, which included
myeloproliferative disorder (bone marrow cancer), aspirin treatment, Coumadin
treatment, platelet disease, renal impairment, disseminated intravascular coagulation.
And out of the 11 bleeding events, 10 occurred in those who had a bone marrow
aspiration AND a bone marrow biopsy (removal of bone core that I repeat again, is not
done in musculoskeletal aspiration for stem cell procedures). The risk of bleeding then
appears to be .005 % for a bone marrow aspiration performed on a hematology patient
with cancer or suspected cancer with no evident risk factors for bleeding. And the risk
of infection appears to be .01%. Reference: Bain, Bone Marrow Biopsy Morbidity: review
of 2003, J Clin Pathol. 2005 Apr; 58(4): 406–408.
Compare that to the risk of a serious complication from a total knee replacement which is
reported to be about 2%, with the 30 day risk of mortality following a total knee
replacement 0.25%. An estimated 25X higher risk for adverse event in a total knee
replacement exists compared to a bone marrow aspiration.
And the complication risk of shoulder arthroscopy is estimated to be 5 to 10%.
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