Back pain is not one diagnosis, and the single most useful thing this practice does is work out which structure is actually generating your pain before anything is injected into it. The pages below are organised around that question rather than around a product.
Dr. Buford is a board-certified orthopedic surgeon. He does not perform spine surgery, and he will tell you plainly when your problem needs one. What is offered here is image-guided, non-surgical treatment of the pain sources that respond to it — with platelet-rich plasma as the primary biologic.
Start with where it hurts
- Pain across the low back, worse standing and leaning backwards, easier sitting or leaning forward. Think facet joints. Start with chronic low back pain.
- Pain low and to one side that you can point at with a single finger, worse standing up out of a chair or rolling over in bed. Think sacroiliac joint. Same page.
- Pain running down the leg, past the knee, with numbness, tingling or weakness. Think nerve root. Start with disc herniation, sciatica and radiculopathy.
- Deep buttock pain that behaves like sciatica but does not follow a clean nerve pattern, and is worse after sitting for a long stretch. Think piriformis and deep gluteal. Covered on the radicular pain page.
- Leg pain and heaviness on walking that eases when you sit down or lean on a trolley. Think spinal stenosis — and read the honest section on it before you consider any injection.
What is actually offered here
Four image-guided injections, all using platelet-rich plasma prepared from your own blood on the day of treatment:
- Facet joint injections — the small paired joints at the back of the spine, and a commonly missed source of mechanical low back pain.
- Sacroiliac joint injections — where the spine meets the pelvis. Deep, irregular, and not a joint to approach without image guidance.
- Caudal epidural injections — for irritated nerve roots, entered through the sacral hiatus at the very bottom of the sacrum, well below the spinal cord.
- Piriformis and deep gluteal injections — performed under direct ultrasound guidance with the sciatic nerve visible on screen throughout.
The full description of each — what it treats, what the day looks like, what it costs and what our own outcomes have been — is on PRP for low back pain.
What is not done here
Worth reading before you book anywhere, not just here.
- Spine surgery — not performed at this practice. You will be referred rather than injected.
- Radiofrequency nerve ablation — not performed here. It is a reasonable option for well-selected facet pain and we will refer you for it.
- Intradiscal injections — not performed here.
- Any injectable stem cell product sourced from a donor — amniotic, umbilical cord, placental and “exosome” products are not legal for this use in the United States and are not offered here at any price.
When back pain is not an injection problem at all
Some presentations need urgent assessment rather than a treatment plan. Seek care the same day for progressive weakness in a leg, a foot that drops, numbness in the saddle area, or any new loss of bladder or bowel control. The same is true of back pain with fever, back pain after a significant fall, or back pain in someone with a history of cancer. None of those are treated with an injection, and no reputable practice should be selling you one.
Why platelet-rich plasma is the primary biologic here
PRP is your own blood, spun down so the platelets are concentrated into a small volume and everything unwanted is discarded. It is used across all four spine injections offered here for three reasons: it comes from you, so there is no donor tissue and no rejection risk; it has no cumulative ceiling in the way that repeated corticosteroid does; and it is the biologic with the most usable evidence behind it in musculoskeletal medicine generally.
The dose matters, and it is the variable most clinics do not measure. Two syringes both labelled PRP can differ tenfold in the platelets they actually deliver. Here the dose is measured and recorded for every treatment, and outcomes are tracked prospectively in a national registry. The reasoning, including the published trials that have not favoured spine PRP, is set out on the chronic low back pain page rather than hidden.
What we do not offer, and why
This field has a marketing problem, so rather than just listing exclusions it is worth stating the standard being applied.
We do not use any product that lacks a clear FDA regulatory pathway for use in humans and clear human clinical outcomes data showing that it is safe and that it works for the indication being treated. Both halves, not either one. That single sentence accounts for most of what is on the market and not on the menu here.
Amniotic fluid, Wharton's jelly, exosomes and regenerative protein arrays
These are marketed heavily, often as “stem cell” injections, and patients are frequently quoted a great deal of money for them. None of them is used here. There are two reasons, and the second matters more than the first.
The regulatory reason. The FDA regulates these products as biologic drugs. None of them currently holds an approved orthopedic indication. That is a description of their regulatory status rather than a matter of opinion, and it holds whatever a clinic's marketing says about it.
The evidence reason, which is the more significant one. Treatment here is based on evidence, and there is no published literature for any of these injectable allograft options in orthopedics showing that any of them works better than PRP or bone marrow concentrate. Not equivalent-but-cheaper, not better-in-a-subgroup — the comparison that would justify using them has not been made in their favour. PRP and bone marrow concentrate, by contrast, have a substantial published human literature behind them.
So even setting the regulatory question aside entirely, there is no evidence-based argument for choosing one of these over a treatment prepared from your own tissue.
Adipose (fat) based treatments, also called microfat
Texas Orthobiologics does not currently offer adipose-based orthobiologics. That is a practice decision, and it is worth separating from the regulatory picture, because the two kinds of adipose treatment are not in the same position.
Adipose preparations produced with a device carrying FDA clearance or approval are regulatory compliant. An adipose-based biologic is often called microfat, after the way clinicians in the United States must process the tissue. It is a legitimate orthobiologic option and some clinicians have success with it.
Treatments based on stromal vascular fraction — SVF — are not currently regulatory compliant. This is now settled, and it is worth being specific about how it got there, because clinics still advertise these injections.
In 2024 a federal appeals court held that SVF is a drug under federal law, and that it does not qualify for the same-surgical-procedure exception that same-day fat procedures had relied on. The Supreme Court declined to review that decision in 2025. On 28 August 2026 the district court entered a permanent injunction on remand in United States v. California Stem Cell Treatment Center, Inc., which also names Cell Surgical Network Corporation. That is not a warning letter or an opinion — it is a standing federal court order.
The practical meaning for a patient is simple. An SVF injection is an unapproved drug unless it goes through the drug approval pathway, whatever the clinic offering it advertises about same-day processing or minimal manipulation. That argument has been made, and it lost.
Every injection here is made from your own tissue
Every biologic injection performed at Texas Orthobiologics is autologous — prepared from the patient's own blood or bone marrow on the day of treatment.
That is deliberately a statement about injections rather than a blanket position on donor tissue. Donor cartilage used as a structural graft in cartilage transplantation surgery is a different proposition entirely: it is regulated under an established pathway, it is implanted rather than injected, and it carries decades of published human outcomes data. It meets the standard above. An injectable donor cell product does not.
Common questions
Do I need a referral to be seen for back pain?
No. You can book directly. What is worth bringing is any imaging you have already had, ideally on disc or accessible electronically rather than as a report alone, and a clear account of what makes the pain better and worse. That history does more diagnostic work than the scan does.
Does Dr. Buford perform spine surgery?
No. He is a board-certified orthopedic surgeon whose practice is image-guided orthobiologic treatment, and spine surgery is not performed here. If your problem needs a surgical opinion you will be told and referred, rather than treated with an injection because an injection was what was available.
Is PRP for the spine covered by insurance?
In the United States, most insurance plans, Medicare and Medicaid do not currently cover orthobiologic treatment. This is an investment you make in your own health rather than a benefit you claim, and you should expect a clear number rather than a vague one. The figures are set out on the PRP for low back pain page, and the number for your own treatment is given plainly at the consultation.
Which page should I read if I have sciatica?
The disc herniation, sciatica and radiculopathy page. Leg pain that travels below the knee with numbness, tingling or weakness is a nerve-root problem and is assessed and treated differently from pain that stays in the back. That page also covers spinal stenosis and the deep gluteal problems that imitate sciatica closely.
