If you’re one of the millions of people following professional golf champion Tiger Woods throughout his career, you already know that he has once again found himself in the “injury bunker” after another recent back surgery, making this the fourth operation in just over three years. This most recent spine surgery, termed a ‘minimally invasive Anterior Lumbar Interbody Fusion (ALIF)’ was elective, and Woods announced his choice was driven by persistent pain in his back and leg despite exhausting all efforts at nonsurgical options. Physical therapy, anti-inflammatory medications and even epidural injections failed to provide enough relief so he underwent the operation in hopes of relieving his continuous back spasms and nerve pain.
The same type of injury in the same location? For many, this sparks questions about the accuracy and successfulness of the first microdiscectomy procedure.
Surprisingly, the answer to both of those questions is no, and there are a few reasons why that may be the case.
First, while the initial procedure did successfully remove the damaged portion of the disc at that time, the disc can continue to undergo structural changes over time, rendering it unstable and raising the chances of it becoming problematic again in the future. That paired with the sheer amount of stress and force that’s inflicted upon the lower spine of a professional golfer, unfortunately created an opportunity for a repeat injury. Due to the fact that Woods had already exhausted all noninvasive therapy options in the past to no avail, another microdiscectomy was necessary to relieve his discomfort. Though the second surgery was deemed successful, he then underwent a third back surgery just one month later in October of 2015, as a follow-up to further relieve discomfort that was still being felt in the lower back. For Woods specifically, this type of lower back injury threatened the future of his career, so his risk/benefit analysis for surgery was in favor of accepting a treatment which would potentially yield results.
Did the surgeries work to cure Woods’ ongoing pain and allow him to get back to the golf course? Yes. But those previous three procedures left the spinal disc in question severely narrowed, and over time it began to cause sciatica and extreme back and leg pain. The solution was his fourth operation to date—an Anterior Interbody Lumbar Fusion (ALIF).
The ALIF procedure involves removing the misshapen spinal disc and fusing together the vertebrae surrounding it into one single solid bone. This treatment becomes an option when motion is the source of symptoms, with the goal that preventing movement of the vertebrae will stop them from causing pain. Woods’ surgeon proceeded with an anterior approach, through an incision in the abdomen. As compared to the microdiscectomy procedure, spinal fusion surgery is a little more intensive, and will take several months before the fused vertebrae(s) become solid. During the first few weeks after surgery, patients are expected to perform basic exercises like walking and with a graduated regimen of rehab exercises, one could typically return to full activity within three to six months.
For Tiger Woods, multiple spine surgeries were a necessity to his future professional golf career, but this same situation requiring more than one surgical procedure can happen to anyone, given their specific circumstances. As previously mentioned, the success of an initial surgery cannot predict the physiological changes that may occur to a spinal disc in the future, as the compromised disc may continue to lose water content, and due to uneven pressure may undergo additional structural changes (such as becoming too narrow in Woods’ case).
Additionally, one surgery cannot prevent future injury or extreme wear and tear, and this fact stands as one of the most common reasons patient’s may require multiple surgeries. Generally speaking, the stakes can be slightly higher for athletes in that they are not on the path to resuming normal activities of daily living, but rather to resuming a sport which places a considerably higher amount of stress on the body and on the spine in particular, making the risk of re-injury higher.
If you are someone who has found yourself back for round two of spine surgery, all is not lost. With each procedure comes a new benefit, a new probability for success, and the chance to be one step closer to a pain-free life.