Orthopedics Magazine Articles
Volume One, Issue Two

Getting better and better
Increased patient satisfaction drives TCO 2008 expansion

Fast and convenient care
AccessORTHO offers urgent, non-emergency orthopedic care

Healing together
Individual and group care improves recovery after joint replacement

If the shoe fits
Feet bothering you? Your footwear may to be blame

Preventing recurrent disc herniations
Twin Cities Orthopedics spine surgeons pioneer technique - annular disc repair

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Preventing recurrent disc herniations

Twin Cities Orthopedics spine surgeons pioneer technique -
annular disc repair

Though spine surgery can be beneficial for people suffering from radiating leg pain caused by a herniated disc, the standard treatment, a microdiscectomy, often leaves patients with recurrent pain. Now, spine surgeons at Twin Cities Orthopedics (TCO) have introduced a new procedure — the annular disc repair, which is reducing patients’ time in the operating room and the chance of reherniation.

Typically, a microdiscectomy was performed to alleviate radiating leg pain. The surgery involved removing the portion of the disc that was applying pressure to the nerves. This procedure required the surgeon to make an incision in the annulus fibrosus, the outer layer of the disc, to access the nucleus pulposis, the herniated tissue. In other cases, a tear in the annulus allowed surgeons easy access to the herniated tissue. However, previously there has been no easy method to close the anulus following the removal of the tissue. Therefore, surgeons commonly left the anulus to heal on its own, which increased the risk of a recurrent herniation.

Many patients found relief with this procedure, but for others, the disc could reherniate through the annulus opening, resulting in the recurrence of pain and requiring additional surgery. Statistics show approximately 30 percent of patients have pain following a lumbar discectomy, and an estimated 15 percent of patients require a re-operation.

But now, with annular disc repair, the procedure provides a new method for treating the compromised tissue of the anulus fibrosus following a discectomy procedure. This innovative treatment is being performed by TCO spine surgeons, John Sherman, MD; David Holte, MD; and Jeffery Dick, MD. After removing the offending portion of the disc, the surgeons are able to re-approximate the soft tissue to facilitate the healing process of the anulus fibrosus. The device designed to re-approximate the soft tissue is the Xclose Tissue Repair System, developed by Anulex Technologies, Inc. For larger defects, a patch is also available, named Inclose.

“This makes a lot of sense,” Dr. Sherman said. “Previously, we have not had a reliable method of closing the anulus of the disc and when it is not repaired, the material inside may re-extrude, compress the nerve root, and result in recurrent pain and re-operation.”

“This annular disc repair procedure adds minimal time to the overall procedure and is easily completed,” Dr. Holte said. After the discectomy, the spine surgeons use the Xclose Tissue Repair System to re-approximate the soft tissue to facilitate the healing process. The surgery is typically done on an outpatient basis. With successful repair of the annulus, the patients can begin rehabilitation and resume their normal activities sooner.

The TCO spine surgeons were the first surgeons to introduce this procedure in Minnesota, and the procedure now is being performed at Fairview Southdale Hospital, Methodist Hospital, and the Centennial Lakes Surgery Center in Edina. For more information about this procedure, please call the Twin Cites Orthopedics’ Centennial Lakes Center at (952) 832-0076 or visit www.tcomn.com.