The Bone Marrow Concentrate (BMC) Procedure
Bone marrow concentrate (BMC) therapy is a concentration of stem cells, immune cells, platelets, and proteins aspirated from a person’s bone marrow and used as a regenerative medicine method. Almost every component of BMC can promote healing and provide benefits for damaged or distressed tissues like joint cartilage and ligaments. If BMC therapy has been recommended for you, here’s what the procedure entails and some additional information you should know.
How the BMC Technique Works
The BMC procedure is a virtually non-invasive outpatient procedure that we perform in our office. On the day of the procedure, you can expect to be in the office for a few hours but the total time for the actual BMC therapy will be around 30 minutes. Before the procedure, your blood pressure and heart rate will be checked. You will also be provided local anesthesia to ensure your comfort throughout the aspiration procedure.
It is a fairly straightforward procedure and involves three distinct steps:
Step 1: Extraction
The physician will have you lay down, usually face down or on your side, on the operating table. You will wear a cloth so that only the exam site will be visible.
Once you are on the table, the physician will mark the spot for extraction, which is usually the posterior iliac crest - the top, back part of the hipbone. In some cases, the physician may choose to use another location.
Once the pelvis is prepped, the bone marrow aspirate will be extracted. This process involves a small incision where a hollow needle navigates into the bone marrow. The needle is attached to a syringe. The syringe retrieves the bone marrow, at which point you may temporarily feel pain. Most patients actually describe the feeling as strange rather than painful. This part only takes a few minutes.
After extraction, the site -- also referred to as the harvesting site -- will remain numb for another one to two hours.
Extraction generally will take about ten minutes and may involve minor discomfort.
Step 2: Concentration
After the bone marrow sample is collected, it is transferred into a sterile, single use concentration device through a filter and placed in a centrifuge. The centrifuge spins, and the speed of it enables the platelets and stem cells to separate from the bone marrow fluid, creating the bone marrow aspirate concentrate.
While the bone marrow sample is placed in the centrifuge, you will remain relaxing on the table. Your pelvis will still be numb and without the needle, you should not experience anymore discomfort.
Concentration generally takes about fifteen minutes.
Step 3: Injection
Once the bone marrow concentrate is ready, it will be injected into the location in need of healing or pain relief. Using advanced technology and imagery, including x-ray and ultrasound, the concentrate is precisely guided to the target tissue and injected.
Injection is quick and takes only a few minutes.
After the injection, the sites of extraction and injection will be cleaned and bandaged. You will also be provided with a care plan specific to you and your injury. Additional injections may be necessary after a period of one to two years to maintain results. Patients typically do not require follow-up injections within days or months with the rare exception of cases in which healing does not appear to be taking place after a period of six to eight weeks.
See How the Procedure Works
What You Should Do Before the BMC Procedure
BMC therapy can be a suitable treatment for people suffering from different bone, tendon, or cartilage injuries. To prepare for BMC therapy, there are two things you should discuss with your doctor.
Medications & Supplements
Advise your physician of any medications or supplements you take. Some medications and even some supplements can increase the risk of bleeding after this type of procedure. Your doctor may want you to stop taking these medications or supplements for a certain amount of time before scheduling the therapy.
Medicines that may cause excessive bleeding after BMC therapy are common blood thinners. Some supplements that may cause excessive bleeding, prolong the effects of anesthesia, or otherwise cause issues with your BMC procedure include:
St. John’s Wort
If you regularly take any of the supplements above, be sure to mention them when scheduling your BMC procedure. Your physician can tell you which, if any, will need to be discontinued in order to maximize the comfort and efficacy of your procedure.
Worries or Fears
Having a procedure done can cause anxiety for anyone. If you are worried at all, discuss it with your doctor. Worrying can cause stress, and stress can impact the effects of the procedure. If you remain stressed about the procedure, your physician may suggest complete or partial sedation rather than only local anesthesia. If so, you can expect to be at the office a little longer for IV anesthesia preparations, and you will need to bring a friend or family member to drive you home afterward.
What You Should Know & Do After the BMC Procedure
Directly after the BMC therapy the extraction site will still be numb. It is advised that you have someone pick you up rather than drive anywhere while the pelvis remains numb.
Also, like after any procedure, you can expect a certain amount of recovery time and possible discomfort. Here’s what you should know and do after BMC Therapy.
Expected Recovery Time & Possible Side Effects
Everyone is different, so how you heal and how fast you are able to bounce back after a BMC procedure is dependent on you, your health, your mental state, and other medical factors or conditions. Typically, the injection and extraction site will heal rather quickly, within a week. Directly after the procedure, you can expect minor bleeding and swelling. There may also be some pain that persists, but each day, this pain should slowly dissipate and disappear within a week or two.
The condition that led you to the therapy likely took years to develop. Since BMC therapy is attempting to right the flawed biological process that caused your condition, it can take some time to accomplish this important work. The rate of healing will depend on your body's ability to recover and may take up to one or two months. You may start feeling some improvement sooner, but true healing takes time. You may have follow-up visits with the doctor to determine how your condition is progressing.
Be mindful of the following rare side effects and contact your physician if you experience any of them:
Excessive bleeding that soaks through a bandage
Excessive bleeding that does not stop with direct pressure
High fever without a known cause
Warm, painful swelling at the site of the procedure
Drainage at the site of the procedure
Progressively worse pain.
Do’s & Don’ts
Pain at the site will not last long, but to alleviate any minor pain you experience at the site of the extraction and/or injection, take Tylenol or another prescribed medication. You can also apply cold compresses to the sites. If any of the above side effects, like severe pain or fever, materialize, contact our office immediately.
If you were advised to refrain from using certain medication or supplements, be sure to check with your doctor to confirm when you can start taking them again. Also, for a few days after the therapy, you want to refrain from high energy sports or exercise. All in all, the experience of BMC therapy should result in quick delivery, quick return to normal activities, and positive pain relief.