Doctors In-Depth: X Marks the Spot - And the Ruptured Disc

Here's the 6 On Health report from Thursday, March 13, 2008. KFDM.com wants to continue to bring you the most complete health news online. Watch KFDM News each night at 10 to get the latest health story. If you miss the show make, remember you can always check right here for the latest story.

The following is a Q&A with Richard Guyer , M.D. about a new X-Close Tissue Repair System is used to prevent future disc herniations....

What is a disc herniation?

Dr. Guyer -- If you think of the disc in simplest form, it's like a jelly donut. The jelly is what we call the nucleus -- that is the part that gives the disc its spongy build -- and the ring of the disc is really like a tire. Those that are familiar with the radial belted tires and the other tires, they have many layers that criss-cross at about a 45 degree angle. So the ring will have a tear, and then allow the jelly to squirt out, and that jelly squirting out then puts pressure on the nerve. By repairing the defect where the jelly has squirted out, then hopefully we lessen the chance of having another herniated disc.

How long is the recovery from this kind of surgery?

Dr. Guyer -- The recovery time is really the same as with the regular discectomy or micro-discectomy. In other words, patients are usually in the hospital overnight, or they go home later that day if we do it early in the morning. So it's less than a 24 hour stay, and then our activities progress depending on the individual surgeon and the patients.

Why is it important to close the tissue during a disc surgery?

Dr. Guyer -- Essentially, we had been doing this type of surgery, that is the discectomies or micro-discectomies, for almost 80 years now, and patients always ask that doctor, ‘If you take out the disc, what are you going to put back in there?' Well, we've never really had a good answer, and then this company came out with the X-Close Tissue Repair System. Before, people attempted to repair the ring of the disc -- this is what holds the soft jelly inside the disc -- but it was very, very hard to get this out of a very, very tiny area. They developed this system that now allows us to repair or to close the effect of the disc itself. This is really the first stage of repairing the disc. Normally we would just remove that portion of the disc that's putting pressure there, but now we can close that portion away. This is important because we do know that patients can re-herniate the disc in as high as 15 percent of cases, and in some studies it even shows higher. When you consider the fact that there are more than 400,000 patients every year undergoing this type of surgery, it becomes important.

So after the disc herniation is removed, surgeons just leave a gap in the disc?

Dr. Guyer -- Yes, there was just a gap there, and you know, I always tell my patient that they have a chance of having a recurring disc issue from up to six months to many, many years out. Tissues do not heal -- it's just a limb that has a tear in it.

How does the X-Close Tissue Repair System work?

Dr. Guyer -- It's a very clever technique using very tiny instruments.  You are able to pass the sutures and into the ring of a disc, that then allows you to sort of criss-cross them, and then close the issue -- to act as a seal and hopefully the scar tissue heals that to keep it from being another herniation, or keep more discs from coming out.

Does this procedure have to be repeated later?

Dr. Guyer -- No, no, you do not have to, no. Once you put the suture in there, it stays there forever.

Who are good candidates for this type of surgery?

Dr. Guyer -- Most patients that have had a herniated disc are good candidates for it -- that is, if they've had their first herniation. If they have a recurring herniation, then because of the scar tissue, they may not be a candidate because there may not be enough tissue to actually repair it.

What kind of success have you seen so far?

Dr. Guyer -- We are currently in the middle of doing the study. It has been approved by the F.D.A., and I think about 1,500 cases have been done. What we're trying to determine with the study is are we indeed diminishing the recurrence of having another herniated disc, and also to study the height of the disc, because one of the consequences of removing the herniated disc is that the disc will narrow and degenerate with time. This is the first step of trying to repair the disc, truly repair the disc. We didn't have anything really to do before, and it's the first step, to repair it. Then after we prove this, technology then may have something to put in the disc as well, and then repair the disc with this technique.

Can this procedure be done on multiple disc herniations?

Dr. Guyer -- Yes, we can use it in one, two, or three.

How did you become involved with this technology?

Dr. Guyer -- Well, I've always been interested in newer technology, and this was sort of the next step. We always wondered if there was a way that we could seal this or repair it, but just physically we didn't have the instrumentation to do it. Now with this technique, with these very clever instruments, we're able to pass the sutures to now get a repair. It's a natural evolution. It's just that technology hadn't caught up to what we needed to be, but now it's better.

How large is the suture you put in the ring?

Dr. Guyer -- Well, if you cut your finger and you go to the emergency room, and they put a little stitch in your skin, we do the same thing with the regular disc. We actually put stitches in it, but because it's such a very small space, we're talking about a space where your visualization might be 5 millimeters in diameter. That's very tiny. Plus, we're working in a deep cone, so to speak, so it would be very hard to pass traditional sutures with a needle holder that we normally do. This is similar to what we do when we do laparoscopic surgery. I do general laparoscopic, but for what the general surgeons do is that it has a band and with the instrumentation, get it to slip off the end, and then we're finished. It's kind of neat.

Does the suture interfere with the body?

Dr. Guyer -- No. It is a very tiny suture. It's a very small suture, so it doesn't do anything.

What do you hope to prove in the study?

Dr. Guyer -- I think that the best hope is that we'll prove there is a low recurrence rate. Another thing, which would be really neat if we could prove with the study, is that we have seen less narrowing of the disc for the degeneration of the disc that it goes on. That's really theoretical. We don't know, but we're studying. The main thing is to determine whether or not we're lessening it.

How many patients are currently enrolled in the trials?

Dr. Guyer -- As far as the study goes, we have about 123 patients involved, but the number for the entire study is much larger than that.

Richard Guyer, MD

Texas Back Institute

Plano, TX

972-608-5016

http://www.texasback.com/