ILC's Treatment for Lumbar Instability
Having been adopted in over 54 countries globally,
the "Cellgel Method" for treating lower back pain
is now available in Japan
For those who have been told it was impossible to operate,
For those who have had recurrence of pain post-surgery,
A low-risk, outpatient treatment is now an option for you.
Table of Contents
This page provides information on the main symptoms and causes of lumbar instability and our treatment procedures. The information includes the method of treatment, treatment time, and information about insurance. We use the Cellgel method, which is one of the most advanced methods in the world, and the characteristics of this method are also described in detail.
Please read this page especially if you have been told that you cannot be cured without surgery, if you have had surgery in the past but have not improved, or if you got better after surgery but the symptoms have recurred.
What is lumbar instability?
Since the spinal column cannot be stabilized by just connecting bone to bone, the vertebrae are stabilized by being fixed to each other by muscles, fascia, ligaments, joint capsules, and intervertebral discs.
Lumbar instability is a condition in which the vertebrae are unable to maintain stability due to muscle weakness, degeneration of intervertebral discs, or deformation of the spine.
When the stability between vertebrae fails and the space between vertebrae becomes loose, the body cannot move normally. This increases the risk of lumbar disc herniation and spinal canal stenosis due to the strain on the lumbar ligaments and nerves.
Main symptoms of lumbar instability
The main symptoms of lumbar instability are often pain in the lower back, buttocks, and legs. Patients who suffer from repeated backaches often have intervertebral instability.
If spinal canal stenosis or other conditions have developed due to vertebral instability, there might also be symptoms of intermittent claudication (pain and numbness when walking, but can walk again after a short rest).
- Pain changes quickly when changing posture
- Difficulty in standing for long periods of time
- Difficulty in half squat / bending
- Difficulty getting out of bed
- Repeatedly having "back spasms" in spite of young age
If you think you might experience of any of these symptoms, we recommend that you have them checked out instead of ignoring them.
Causes of lumbar instability
Lumbar instability is often attributed to aging, lifestyle habits such as poor posture and walking habits, muscle weakness, and oxidative stress.
These causes begin to cause damage (fissures) to the intervertebral discs. The nucleus pulposus, which is the source of the cushioning the bones, leaks from the damaged area, and the intervertebral disc itself decreases in size and its cushioning function declines. The loss of the cushioning function places a strain on the bone, causing bone deformity.
These degenerative and deforming processes cause the structure to become unstable. Continued instability is said to cause back pain due to overworked muscles, and lower limb pain due to nerve damage caused by bone deformation.
When the volume of the intervertebral disc is normal, the vertebrae are in proper alignment with each other, and stabilizing mechanisms such as muscles and ligaments work smoothly.
When the disc volume decreases, the space between the vertebrae narrows,
the stabilizing mechanisms from muscles and ligaments fails, and causing the spine to become unstable.
What are the effective treatments for lumbar instability?
Although conservative treatment is common in the initial stages of treatment, surgery is often recommended if the condition does not get better and has been prolonged, and if the bone has slipped (spondylolisthesis). Surgical treatment of lumbar instability and spondylolisthesis often involves surgical procedures to reduce pressure on the nerves. These include spinal fusion, in which muscles and ligaments are removed to immobilize the unstable bone, and endoscopic procedures in which some lumbar vertebrae are shaved and enlarged ligaments are removed to close off the pressure. However, sometimes the inflammation does not subside and does not improve after surgery, or the pain recurs.
Surgery is not a fundamental treatment as the cause of the pain may not only be related to the spine or intervertebral disc, but also other factors such as body constitution, muscles, and ligaments.
In the case of lumbar instability, pressure on nerves and worsening of symptoms are attributed to disc deformity.
Therefore, our clinic believes that if the deformation of the intervertebral disc can be controlled, bone deformation, ligament hypertrophy, and other inflammation related to nerve compression can be prevented.
Therefore, we believe that if we can control the degeneration of the intervertebral disc, we can prevent inflammation related to nerve compression, such as bone deformation and thickening of the ligaments. Our disc repair treatment using the Cellgel method restores disc function by repairing the torn annulus fribrosus and replenishing the water content of the nucleus pulposus inside.
The treatment can be performed as a one-day procedure. Local anesthesia is given to the lower back, a needle is inserted into the disc, and a chemical solution is injected.
It takes about 25 minutes and patients can go home after resting for about an hour.
The removal of the bone and part of the disc that is compressing the spinal canal relieves pressure on the spinal canal, but the spine becomes unstable, so an artificial disc is inserted and the bone is secured with a metal device called a bolt and rod.
Since many of our patients come from far away,
we are happy to give free consultations to see which treatment is best for you
We'll diagnose your MRI images for free！
Treatment at ILC
There are four main treatments at our clinic.
As mentioned above, the root cause of each back pain disease is "inflammation and deformation due to aging of the intervertebral discs." Although the four treatment methods have different features and advantages, we would like to first introduce the "Cellgel method," which is the only one capable of intervertebral disc repair.
The Cellgel Method
The Cellgel method is an advanced treatment for low back pain that has been implemented in more than 54 countries worldwide, predominantly in Europe.
As with other treatments, it does not decrease the disc volume, and since the drug remains in the disc as a gel-like implant after treatment, the disc can be preserved. Recent studies have also shown that the volume of the disc increases after treatment.*1
It is also thought that by repairing the disc and preventing leakage of the Nucleus Pulposus, the disc itself will restore its normal function with its own regenerative ability (*2).
It is particularly recommended for patients who are concerned about the risk of conventional disc surgery (MED, PELD, etc.).
*1 Source: European Journal of Radiology 109 (2018) 101–107 , Efficiency of an ethyl alcohol gel in symptomatic disc hernation
*2 Source: International Journal of Spine Surgery Vol. 15 Appendix 1 from regenerative treatment of disc degeneration
"Very good or good results were obtained in 202 (91.4%) of the 221 patients in group A. Of the 44 patients in group B, 37 patients (84%) presented very good or good results and in 9 (82%) of the 11 patients of group C, we obtained similar results. There was no allergic complication in any of our patients. Long-term follow-up magnetic resonance showed a dramatic reduction in hernia volume."
- Dr. J. Theron, one of the world's leading experts in the treatment of Celgel method, from his research article "Percutaneous Treatment of Lumbar Intervertebral Disk Hernias With Radiopaque Gelified Ethanol - A preliminary study."
Actual Treatment Images of the Cellgel Method
Fluoroscopic image view from the back
Fluoroscopic image view from the side
Fluoroscopic image view from the side
Fluoroscopic image view from the back
Merits of Cellgel
- Possibility to repair intervertebral discs where unable to using surgical or laser treatment
- As the disc is repaired, the disc itself regains its original normal function through its own regenerative ability
- The Cellgel method uses local anesthesia over general anesthesia used in conventional surgery, making it less burdensome on the body
- Treatment is done with a thin needle, so the wound is minimal and recovery is rapid
- Treatment is very short, allowing for outpatient day treatment
- Safe, modern treatment proven in more than 54 countries around the world
Flow Cellgel Treatment Process
MRI and X-rays will be taken, followed by a doctor's diagnosis.
If the diagnosis proves the Cellgel method suitable , treatment can begin that same afternoon.
After entering the treatment room and administering local anesthesia to the lower back, a needle is inserted into the intervertebral disc identified in the examination.
A contrast scan is performed to confirm the location of the damaged disc.
The Cellgel drug is administered to the damaged area while confirming the location of the disc with a fluoroscopy device.
Once the drug has been absorbed, the needle is removed and the bleeding is stopped.
After the treatment, the patient rests in a private room for about an hour, and then allowed to go home after the post-treatment examination.
*Resting time depends on the patient's symptoms and condition.
Price Cost of Treatment for the Cellgel Method
|1 disc||2 discs||3 discs||4 discs||5 discs|
|Treatment Cost||1,420,000 JPY||1,530,000 JPY||1,640,000 JPY||1,750,000 JPY||1,860,000 JPY|
*The prices listed are inclusive of tax.
*All medical and diagnostic costs, including MRI and other tests, as well as medical translation and interpretation fees, are all included in the treatment costs listed above.
*If the same treatment is performed again within 3 years after the first treatment, fees will be reduced by half.
*The treatment is not covered by the Japanese health insurance, one must privately bear the entire cost of the treatment.
*Payment by credit card (Visa, MasterCard, UnionPay) is accepted for the treatment costs only.
*If you also wish to receive rehabilitation (specialized rehabilitation for back pain), payment can be made by bank transfer.
*You can receive a tax refund by filing a tax return for medical expenses.
FAQ FAQ about lumbar instability and treatment
QWhat's the difference in the reccurence rate between Cellgel and conventional surgery?
Surgical procedures, which began in the 1960s, aimed to remove and sometimes fix deformed bones and herniated tissue. However, new bone damage caused by screws and the lack of fundamental treatment (repair of the intervertebral disc annulus fibrosus) resulted in the appearance of additional back pain and recurrence rates.
Therefore, in the 1980s, the need for fundamental treatment increased, and the intervertebral disc treatment (Cellgel) that we provide at our clinic began. Cellgel, in particular, have been proven to repair and regenerate the intervertebral disc, resulting in not only improvement of symptoms, but also an extremely low recurrence rate.
QHow is the disc to be treated determined?
AThe doctor will spend about 30 minutes with the patient while looking at the MRI and X-ray images to determine the cause of the condition, determine the treatment area, and explain the corresponding treatment method to the patient. MRI images show the main factors that contribute to back pain (disc, nerve, ligament, and joint), such as changes in shape, pressure on the nerve, presence or absence of damage, and inflammation. The x-ray image mainly confirms the condition of the bones.
QWhy is the Cellgel method applicable to cases where surgery showed no improvement?
ADuring surgery for disc herniation, the prolapsed herniation is removed, but the damaged disc remains intact. As a result, fresh nucleus pulposus components leak from the damaged disc and inflammation persists. On the other hand, our treatment can treat the disc injury itself, thus suppressing inflammation by reducing the fresh leakage of nucleus pulposus components.
QMy back pain may temporarily worsen after treatment. How long will it last?
AThe reason for the lower back pain is that spinal ligaments that have been compressed are stretched; the lower back pain lasts for about two weeks and then subsides.
QWhat level of exercise can I perform after treatment?
AGeneral recreational exercise and sports can be done without any problem. For professional athletes, the possibility of new disc damage is high and should be discussed in consultation with a doctor.
QPlease tell me about what I should be cautious about after treatment.
ADuring the first few days after treatment, the patient should rest and avoid prolonged sitting, heavy lifting, twisting, bending, or strenuous exercise. Patients should be able to perform routine tasks one week after treatment and should be able to perform light exercise by the second week. Weight training is allowed after 3 months.
QIs the treatment covered by the Japanese national health insurance?
ANo, it is not covered by the national insurance. If you have life insurance, you may be eligible. Please feel free to consult our staff regarding this matter.
QHow long must I wait to be able to walk after treatment?
AIt is an outpatient/day treatment, so you can walk about an hour after the surgery.
QHow many doctor visits do I need to make before treatment?
AWe require an MRI to be taken within three months for remote diagnosis, either with our affiliated clinic or from data sent by you. You can receive treatment on the same day after phyiscal diagnosis. You may also request only the diagnosis and come back only for the treatment at a later date.
QCan I fly immediately after the treatment?
AIf there are no problems after the treatment, you may fly. If there is any pain after the treatment, flying may not be recommended depending on the doctor's evaluation.
QWhat should I be cautious of when I have lumbar instability?
AOnce you have been diagnosed with lumbar instability, the first step is to prevent further disc and bone degeneration. If you perform a lot of back-straining activities or tasks, reduce the frequency of such movements, and listen carefully to your doctor's advice to determine what you should do next.
QWhat's the difference between lumbar instablity and disc herniation?
AA herniated disc is a case in which the nucleus pulposus in the intervertebral disc protrudes outward and compresses the nerve, causing pain and numbness. Lumbar instability refers to a condition in which the spine becomes unstable due to deformation of the vertebrae, intervertebral joints, and ligaments, including the disc, or weakness of the muscles that support the spine, resulting in inflammation and pressure on the nerves, causing pain and numbness. As lumbar instability worsens, spinal canal stenosis or spondylolisthesis disorder may also occur.
QCan lumbar instability be cured without surgery?
AUnfortunately, there is no complete cure for bone deformities.
It is possible to reduce inflammation and prevent the worsening of pain and progression of symptoms by relieving symptoms and improving the overall physical condition of the patient.
QAre there medications to cure lumbar instability?
Medication will not fundamentally cure the disease.
However, medications may be prescribed to relieve pain and improve blood flow. For severe pain, it may be necessary to take painkillers. Patients who have been taking medication for a long time may experience other pain and side effects if the medication is abruptly stopped.
QCan I continue working if I have lumbar instablity?
It is possible to continue, depending on the severity of the symptoms.
However, if your job involves a lot of desk work or heavy labor, you need to refrain from such work as much as possible, as it is hard on the lower back.
If it is difficult to change your work environment, consider improving your physical condition, posture, and muscle strength. If these methods improve the condition, we recommend that you continue to use them.
If there is no improvement, we recommend that you consult a doctor and receive a diagnosis.
ILC Rehabilitation X Lumbar Instability Treatment
Although the Cellgel method can repair and regenerate the disc itself, and other treatment methods we offer can fundamentally heal the disc; it is possible that the cause of back pain is not only the disc, but also muscles, joints, and ligaments that are affected by the disc.
In cooperation with our rehabilitation specialists, we recommend treating back pain caused by muscles, joints, and ligaments together.
We also offer a short-term intensive program for patients who live far away or overseas.
ILC's Low Back Pain Treatment
Improve back pain disorders/
symptoms in relation to the nerves
ILC's Rehabilitation Program
Specialized Low Back Pain Rehabilitation
Improve back pain disorders/symptoms in
relation to the joints, muscles, ligaments
ILC's Specialized Back Pain Rehabilitation
Our Rehabilitation Approach to Lumbar Instability
Lumbar instability can be caused by a variety of factors, including disc degeneration and muscle weakness around the lumbar region.
To alleviate the symptoms of lumbar instability, it is necessary to identify which part of the body is causing the problem and destabilizing the lumbar spine structure.
If the problem is related to disc degeneration, the Cellgel method is recommended to improve the stability of the disc.
If muscle strength is a factor, exercise therapy such as strength training is necessary.
ILC's Specialized Back Pain Rehabilitation
How to Evaluate Lumbar Instability
In order to understand the state of lumbar instablity, a consultation is held with the doctor to determine the damaged site and shape based on imaging findings, and to determine the area under stress, and the condition of the intervertebral discs and joints.
Using the findings as a reference, we will evaluate the aggravating and mitigating factors of the symptoms in the posture and movements of daily life while actually moving the body slowly.
Aggravating factors are defined as movements that should not be performed, and mitigating factors are symptoms that can be alleviated by doing certain body movements.
We will comphehensively evaluate these factors with muscle strength and stiffness to find out why lumbar instability has developed and pain symptoms have appeared.
ILC's Specialized Back Pain Rehabilitation
Rehabilitation Treatment for Lumbar Instability
Rehabilitation treatment method for lumbar instability
Lumbar instability is a condition in which the vertabrae become unstable and it carries a high risk of developing complications such as lumbar disc herniation or lumbar spinal canal stenosis.
In some cases, the intervertebral disc simply collapses without any other complications.
Depending on these factors, the rehabilitation program will vary greatly.
There are three main types of rehabilitation for lumbar instability:
- i. Heat therapy aims to reduce blood flow obstruction and increase recovery by warming the blood flow locally and systemically.
ii. Strengthening the core (inner trunk muscles)
- Simultaneously contracting the transverse abdominis and multifidus muscles
- Simultaneously contracting the diaphragm and pelvic floor muscle group
Leads to increase in intra-abdominal pressure and improvement of lumbar support between lumbar vertebrae
- iii. Improvement of balance between back and abdominal muscle groups, correction of habitual muscle usage and tension caused by poor posture
- iv. Training of rectus abdominis and oblique abdominis muscles to support increased intra-abdominal pressure linked to deep abdominal muscles.
- v. Acupuncture to improve blood flow obstruction and increases physiological recovery through temporary pain relief
Improving Posture and Mobility
- i. Correcting muscle and joint movements related to unnatural posture (e.g. slouching)
- ii. Improving mobility of the thoracic cage and flexibility of the glutes
- i. Providing highly restorative meals
- ii. Home dietary guidance
We take into account the natural structure of the human body in order to remove the parts of our lifestyles that are causing the symptoms.
- Physical Therapy
ILC's Specialized Back Pain Rehabilitation
Treatment Period for Lumbar Instability
Lumbar instability is a disorder with many complications. The duration of treatment varies greatly depending on the presence of complications and the environment (frequency, location etc.) in which the patient can continue rehabilitation.
If there are no complications and the patient only has a single symptom such as low disc height, the inflammation itself tends to subside in about two weeks after Cellgel treatment.
Once the patient is able to use the core of the trunk (inner muscles), which support the spinal column, back pain is reduced.
If there are other complications such as disc herniation, the patient should be observed for six months to a year.
Symptoms can vary greatly depending on whether or not the patient is able to implement disciplined self-care during rehabilitation instruction.
Since the body changes over time, rehabilitation should be tailored to the changing symptoms and body rather than continuing to do the same thing throughout the year.
We aim to achieve 100% effectiveness of treatment while incorporating the latest technology, so we spend at least 30 minutes with each patient to carefully and meticulously examine the patient's concerns in order to make a proper diagnosis and propose the most suitable treatment methods.
We are certain to find a way to alleviate or eliminate the pain and numbness you are experiencing, so please do not give up and give us a call instead!
- Tadaaki Minowa, Clinic Director