In the wake of Tiger Woods’s arrest on Memorial Day for driving under the influence, much attention has been paid to his drug use. The incident — wherein he was found asleep at the steering wheel while his car stood in the right lane — was, the golfer said, not the fault of alcohol but rather “an unexpected reaction to prescribed medications.”
But what’s been less discussed is the role of the back surgery Woods recently underwent, called spinal fusion. Woods had the surgery in April “to alleviate ongoing pain in his back and leg,” according to his website. (This was his fourth back surgery.)
According to the police report, one prescription Woods has is the opioid pain reliever Vicodin, possibly related to the back surgery — though Woods’s agent would not say if that was the reason, according to the Washington Post.
But the incident points to a bigger problem with such surgeries: Spinal fusions are rising in prevalence even though they often don’t work, leave patients in pain, and can drive patients to long-term dependence on pain relievers.
Here are six things to know about spinal fusions and prescription medication.
1. Spinal fusions are increasingly common
Hundreds of thousands of Americans undergo this popular procedure every year to relieve back pain. Many receive prescription opioids afterwards. From 1998 to 2008, the number of spinal fusion surgeries more than doubled, from 174,223 to 413,171, according to a paper published in the journal Spine.
2. Many people become dependent on pain relievers after back surgery
Doctors are worried about the rising rate of opioid prescriptions for surgery-related lower back pain. The surgery is intended to relieve pain, but it’s also often associated with pain of its own.
In a paper published this year in Spine, researchers found that about 20 percent of patients who underwent lumbar fusion surgery continued to take opioids two years after the surgery.
“There is widespread concern about long-term opioid dependence among patients who undergo spinal fusion surgery,” researchers wrote. “Moreover, the efficacy of long-term opioid use for low back pain following spinal fusion surgery is widely debated.”
3. The surgery is often done when it’s not needed
There is a growing controversy about whether spinal fusions are necessary all of the time. Without knowing more about Woods’s medical conditions, it’s impossible to even ask that question of his surgery in particular.
Scientific studies have found that spinal fusion might not work any better than other, non-surgical interventions.
And in 2013 the Washington Post reviewed patient records in Florida, identifying thousands of cases of spinal surgeries being conducted in cases that experts might deem unnecessary.
4. As an alternative to surgery, opioids aren’t much better
The American College of Physicians’s guidelines on back pain, published in April, warned against using opioids to treat back pain — in part because there’s little evidence showing they work well, and in part because of their dangerous side effects.
“Opioids should be the last treatment option considered and should be considered only in patients for whom other therapies have failed because they are associated with substantial harms,” the group wrote, referring to patients with chronic low-back pain.
5. Doctors get paid big bucks to do these surgeries
The Washington Post noted that surgeons may be incentivized to perform costly fusion procedures when cheaper, simpler ones may suffice — because then the surgeon will be able to charge more. Spinal fusion can bring in $6,000, while a cheaper “decompression” surgery might only net $1,000.
6. But spinal fusion may not help people in the long run
If back surgery doesn’t help you get back to living a normal life, then what’s the point? A team of Ohio researchers tackled this question in a 2011 Spine paper in which they examined individuals who were injured at work. The findings did not bode well for the surgery.
“This procedure is offered to improve pain and function, yet objective outcomes showed increased permanent disability, poor [return-to-work] status, and higher doses of opioids,” the authors wrote.
No question too many lumbar fusions are done, especially for back pain without evidence of instability (e.g. significant, preferably progressive, spondylolisthesis). The 2011 article from Spine cited probably exaggerates, however, and demonstrates difficulty of retrospective studies. It compared results in 725 lumbar fusion workers comp patients with results from 725 randomly selected low back pain workers comp patients. But the 725 operated patients could have been selected, by the surgeons, from 5000 low back patients,similar to the control group, and they picked the worst patients.
We don’t know. Impression: there are good reasons for fusion, but far too many fusions are done without good reason (ability to pay is not a good reason). –retired neurosurgeon.
Recalling his really bad night when he got clubbed on the head and then ran into a tree – I have often wondered if Tiger has ever had a functional MRI of a SPECT scan, either of which could best identify or rule out the possibility that he suffered a TBI that night.
Insightful dude I am huh.
Surprised such a poor article has come on Doximity. For many patients with cervical disc herniations and lumbar spondylolisthesis, spinal fusions have shown significant benefit and are listed by the North American Spine Society as standards of care in their guidelines. Spinal conditions are becoming more common as patients are living longer and technologies & surgical techniques improving with better outcomes. Each spinal condition is unique and treatments from conservative to surgical are considered according to each individual patient. Tiger Woods is such an example. Many of my patients have come off narcotic pain medications and returned to more useful work and activities after spinal fusion surgery.
Shah N. Siddiqi, MD, FRCSC, FACS,
Assistant Professor of Clinical Neurosurgery, Houston Methodist
Let the discussion begin! As a Orthopaedic Surgeon with 30 years experience; there is no doubt that modern diagnoses and surgical technique offer unprecedented success in the alleviation of incapacitating back pain. However, the alternative truth is that these lucrative surgeries are unquestionably over done. Many are still left dependent on opioids.
I don’t know the specifics of Tiger’s case, and the article referenced is hyperbolic. Yet, this is a discussion that needs to be had!
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