Dr Richard D. Guyer is a board certified orthopedic spine surgeon with a long list of very impressive accomplishments, including being a co-founder of The Texas Back Institute. Dr Guyer finished his own Fellowship training in spine surgery in 1982 and now directs Spine Surgery Fellowship Program that has trained more than 70 surgeons using the latest technologies for spine surgery.
Dr Guyer, thank you so much for taking the time to share some of your expertise and ideas with us. We certainly appreciate it. Please start off by telling us a little bit about yourself and The Texas Back Institute.
Having been in practice since 1982, I am a spine surgeon and one of the co-founders of the Texas Back Institute. More than 30 years ago, my co-founders and I shared a vision and formed the first multidisciplinary spine institute in the United States.
In addition, we feel strongly about research and subsequently formed the non-profit Texas Back Institute Research Foundation in 1985 where we continually study the latest medical advancements as we seek to help make patient care better for spinal patients.
Our research over the years has involved leading and participating in many FDA studies across a wide range of innovations such as electromagnetic stimulation of bone healing and artificial discs for the cervical and the lumbar spine.
As a national leader in spine research, the foundation has participated in 14 FDA total disc replacement studies. Texas Back Institute remains a national leader for disc replacement as well as minimally invasive and deformity surgical procedures.
1. Do you always try conservative treatments before deciding to perform surgery on someone with back pain?
Absolutely. In fact, the majority patients will respond to non-operative treatment, and only a very small percentage of patients become candidates for surgery. We address proper rehabilitation through core strengthening exercises, weight loss, and the use of non-narcotic anti-inflammatory medications.
2. Should people try all of the conservative treatments before getting an appointment with a surgeon? What kinds of therapy can people do to avoid back surgery?
In general, most large spine centers have physicians who are trained in the non-operative care of back problems. This should always be the first resource. However, in many cases, although the spine surgeon is the first point of contact for the patient; non-operative treatment is recommended as the first step unless the patient is at risk for further neurologic damage.
The non-operative treatment, as I alluded to above, includes active physical therapy, utilizing therapeutic exercises to alleviate the pain, as well as strengthening exercises along with core exercises and balance. Oral anti-inflammatories, such as Aleve or Advil are also helpful. There are a number of prescription anti-inflammatories as well. Sometimes muscle spasms are present, and medications that control these are helpful as well as the use of stronger narcotic pain medications.
3. When weight loss and exercise are recommended as a treatment for people with back pain, what do you tell people who say that they can't exercise or lose weight because of the pain?
Answering the first part of the question, weight loss and exercise are always recommended in the initial treatment and care of back problems. Weight loss alone is not going to cure a patient if they are overweight, nor will exercise alone.
A combination of diet to reduce weight and exercise is necessary, as well as learning proper body posture and body mechanics, having the proper seating posture and appropriate ergonomic setup of the patient’s work station on the job, if applicable.
When patients feel they can’t exercise or lose weight, I always recommend they be evaluated by the therapist. Often times, if they cannot do land exercises, pool therapy can be very helpful in getting them started.
4. When talking to a patient about surgery, how do you balance the risks of surgery against the benefits?
I always have a frank discussion with the patient outlining the risks and the benefits. I tell them what the relative percentages are of improvement following surgery and also talk about the risks involved with their individual cases. Every person has to make an individual decision.
5. Rapidly advancing technology is affecting every field. How is it changing the way you perform spine surgery? What are some of the newest procedures that you are performing at The Texas Back Institute?
This is a very exciting time to be in medicine, in particular spine surgery, as many of the surgeries we do today are totally different than what we did 20 years ago. Now we are able to do major reconstructive surgeries, including fusion from the front as well as the back, often known as the “360” fusion, in the same day and discharge the patient the following day.
We now have artificial disc replacements that allow patients to get back to work faster and return to normal activities. Minimally invasive surgery is allowing us to do more surgery without making large skin and internal incisions.
Biologics are being utilized more frequently, especially with fusion surgery. We no longer have to take bone graft from the patient’s hip as we now can use biologic bone growth stimulators. We are also doing research into the regeneration of a degenerative disc through biologic substances.
6. Having clinical trials at The Texas Back Institute for the second generation of artificial disc replacements puts you right at the cutting edge of the latest technology. Are there any new trials in the planning stages now? How can people find out about getting involved in future trials?
As we stated earlier, we have been in involved in 14 cervical and lumbar artificial disc trials and continue to pursue newer trials. In fact, we have two new trials coming up, one in the cervical and one in the lumbar spine. I recommend the prospective patient go directly to our website at to learn what research protocols are available or contact our Texas Back Institute Clinical Research Organization directly.
7. Do people need a referral from a doctor to be seen at The Texas Back Institute?
No. The patient may make an appointment without a referral; however, the advantage of being referred by a physician can ensure that the patient comes in with many of the basic studies already completed that will allow the evaluation to proceed much more quickly.
8. When you attend conferences and read the latest literature, what are people talking about? What kinds of things are on the horizon for treating back pain?
Currently, minimally invasive surgery is becoming much more prominent as well as the use of biologic and genetic engineering to help diagnose and treat some spine deformities. There are now genetic screenings for certain types of scoliosis, and soon we will have the ability to screen those individuals who are prone to develop degenerative disc disease.
We have various biologics that are being used to treat many different conditions, including regeneration of the disc. Long-term five year follow up studies of disc replacement procedures are beginning to appear, confirming the safety and effectiveness of disc replacement options and returning these patients back to normal activities.
Dr Guyer, how interesting and exciting it must be to be involved with making such wonderful advances in the field of spine surgery.
It must be gratifying for you and your colleagues at The Texas Back Institute to be part of how things have changed, from the big open surgeries 30 years ago with massive blood loss and months of recovery, to tiny incisions and patients up walking the next day.
We would like to thank Dr Guyer again for taking the time to answer our questions and share his knowledge with us. His thoughts about conservative therapies are appreciated, and his vision of the future possibilities for treating spinal conditions is certainly thought provoking.
The Texas Back Institute is certainly a leader in the world of spinal surgery and other treatments for back pain. You can learn more about the latest advances and how they may apply to you by going to their website at The Texas Back Institute.