Use Caution When Comparing “Most Patients’” Spine Surgery Results to those of Professional Athletes
Reports have circulated recently that Tiger Woods’ back condition may have worsened following repeated microdiscectomy surgery. Specifically, Golf journalist Robert Lusetich noted that Woods “can’t move well” and has trouble sitting. Lusetich added that while microdiscectomies are successful over 90% of the time, Tiger Woods has simply been “unlucky.”
On the surface, Mr. Lusetich is correct. The vast majority of patients who undergo lumbar microdiscectomy surgery experience excellent results. Tiger Woods also got a good result. However, what Mr. Lusetich may have failed to take into consideration is that Tiger Woods is no “ordinary patient.”
Before we can analyze this commentary, we need a bit of a brief spinal anatomy lesson. The discs between each vertebra of the spine act as individual shock absorbers. This shock absorption material is normally held in place by a very dense and strong ligament. Over time, repeated mechanical movements decrease the integrity of that ligament. Once the ligament’s integrity is compromised, the disc can herniate or bulge outwards and place pressure on surrounding nerves. Once those affected nerves are compressed, the person experiencing the condition often feels pain, numbness, and even weakness in the spine and sometimes extending to the extremities.
A microdiscectomy procedure involves removing the part of the disc that has herniated outward beyond the dense ligament. Tiger Woods has had two of these procedures. One was completed in 2014 and the other in 2015. What Mr. Lusetich may not have known when writing his article is that there is a finite amount of disc material at each spinal level. While a microdiscectomy can be performed multiple times at a given level of the spine, the spinal segment will eventually run out of shock absorption material. Once this occurs, there can be bone on bone contact between the vertebrae. This, in turn, can lead to worsening back pain and spinal stiffness. Once this occurs, a patient often will need spinal fusion surgery to correct the problem and relieve the pain.
Most people who undergo a microdiscectomy get excellent results because they do not repeatedly stress their spinal “shock absorbers” to the extent that professional athletes like Tiger Woods do. More often than not, a herniated disc is caused by lifting a heavy object or by a trauma such as a motor vehicle collision. Sometimes, there is no specific cause that can be attributed to the development of a herniated disc. In the case of a professional golfer such as Tiger Woods, there is a massive amount of force that is transmitted to the lumbar spine with each swing of the golf club. This can lead to weakening integrity of the dense ligament that holds the discs in place. Even after the most successful surgery, performed by a world-class spine surgeon, the ligaments will eventually weaken again when subjected to repeated physical stress. This forceful repetition over time on an already weakened level of the spine can result in total elimination of the disc material. This then leads to worsening back pain, difficulty with movement and in some cases, risk to other parts of the spine.
Tiger Woods isn’t the only professional athlete who has had microdiscectomy surgery. In 2012, Dwight Howard, then playing for the NBA with the Los Angeles Lakers, also underwent microdiscectomy surgery. While Howard recovered fully from the procedure, he hasn’t performed at his peak level since. As is well-documented, Howard’s scoring and rebounding numbers are significantly down from his career highs. These stats have led to quite a bit of speculation that the Houston Rockets were trying to move him before the NBA trade deadline. While Howard is not complaining of any back pain, leg pain, or sciatica at this time, the repeated stress on his lumbar spine by running up and down the hardwood on a nightly basis is certainly not helping his cause.
These examples aside, to say that lumbar microdiscectomy invariably leads to the downward spiral of a professional athlete’s career would be inaccurate. New England Patriots tight-end Rob Gronkowski had the procedure in 2013. As his performance in the 2015 season has demonstrated, Gronkowski did just fine. Tony Romo of the Dallas Cowboys also had microdiscectomy surgery in December of 2013. While he has had other health issues to deal with since then, he appeared to fully recover from the spine surgery and has had productive and successful seasons since.
The bottom line is that microdiscectomy is usually a very safe and effective procedure for a majority of patients. Even in professional athletes, a full recovery can be attained. But with continued and forceful wear and tear that professional athletes place on their lumbar spines, the shock absorptive material eventually disappears. And when this happens, increasing back pain and stiffness can set in. It isn’t the fault of the microdiscectomy procedure, it is simply the result of stressing the spine beyond its intended capacity.