Many individuals afflicted with back pain look to the experience of professional athletes as they try to decide how to treat it. When sports figures’ backs give out, they don’t adopt a wait-and-see attitude. Instead, they seek help immediately, from a shortlist of high-profile spine surgeons who drop everything to care for them. After their procedures but before they return to the court, field, or course, these players undergo weeks of arduous physical rehabilitation. But the public never sees that grind. Instead, we see that, in record time, they’re back to work, fulfilling the requirements of their multimillion-dollar contracts.
Except when they aren’t.
Failed back surgeries for Steve Kerr, head coach of the Golden State Warriors, and golf legend Tiger Woods offer cautionary lessons about surgery for back pain.
Kerr chose to have disc surgery in July 2015 to relieve pain caused by an intervertebral disc — the shock absorbers that sit between the individual bones of the spine — pressing on a spinal nerve. In this procedure, called microdiscectomy, a portion of the disc is removed. It can help some people get back on their feet, especially if they actively rehabilitate the muscles and ligaments affected by the procedure and address the underlying weakness that caused the problem in the first place.
What often goes unmentioned is that, after two years, the outcome for those who opt for surgery and those who pursue conservative care is essentially the same. For most people, after a few weeks or months, the protruding, pain-causing disc tissue shrivels up and disintegrates, and the pain fades away.
What Kerr recognizes now, as should everyone contemplating back surgery, is that it can come with significant risks. In his initial operation, the surgeon nicked the dura, a tough membrane enveloping the spinal cord. That created a cerebrospinal fluid leak that resulted in headaches, nausea, and severe pain. After his first surgery in July 2015, Kerr sat out dozens of games.
To fix the leak, he underwent a six-hour surgery in September 2016. Months after that procedure, Kerr was still suffering from low back pain and nerve pain, in addition to headaches, blurry vision, and neck pain.
Last month, Kerr checked into the hospital for another spine procedure. The intention was to finally track down the cerebrospinal fluid leak and patch it. Although it is too soon to say for certain, it appears that this time the effort may have worked. After missing most of the Warriors’s undefeated playoff run, Kerr was courtside and looking good in game two of the NBA finals, and he got a standing ovation. The word was that he felt better, and intended to handle coaching duties himself throughout the remaining games.
Tiger Woods’s odyssey to ease his back pain has been equally tortuous. To remove disc tissue that surgeons said was putting pressure on spinal nerves, he underwent microdiscectomy procedures in March 2014, September 2015, and October 2015 to attempt to stop his back pain. Three months after his third surgery, Woods, sounding hopeless, told reporters at a press conference that he didn’t know when or if he would be able to play golf again. “I have no answer for that. Neither does my surgeon or my physio,” he said. “There’s no timetable. There’s really nothing I can look forward to, nothing I can build toward.”
The golfer’s decision to go under the knife again this spring, this time to have spinal fusion (also called lumbar spinal fusion), reflected his desperation. Spinal fusion connects two or more vertebrae in the spine, eliminating motion between them. This procedure usually limits one’s ability to twist the torso, and following fusion other parts of the spine often begin to deteriorate, creating additional problems.
Last week, mug shots of Woods — his face puffy and his eyelids barely at half-mast — were splashed on media sites around the world after he was charged with driving under the influence in Jupiter, Fla. His car was substantially damaged, the tires flat. Woods was asleep, and difficult to wake, when the police discovered him. He hadn’t been drinking, but instead said in a statement that he had “an unexpected reaction to prescribed medications.” Normally, people at his stage of recovery from spinal fusion wouldn’t be behind the wheel.
Spinal fusion has been shown to succeed in barely 40 percent of patients. In this context, though, “success” doesn’t mean much. In one study, two years after what was deemed to be successful spinal fusion, pain had been reduced by barely half, and most patients continued to use prescription painkillers. In another study, about one-third of patients reported that their pain was as bad two years after surgery as it had been before they’d had the operation, and 14 percent believed that they were in worse shape after spinal fusion than they’d been beforehand.
Writing in the American Journal of Medicine, two University of Mississippi researchers observed that, in the United States alone, about 80,000 spine surgeries fail every year. People who do not do well are referred to as “failed backs,” and often return repeatedly to the operating room with the odds stacked against them, losing ground after each procedure.
Even when the operation goes perfectly, what works for many pro athletes won’t necessarily work for you and me. Why not? Professional athletes are usually superb physical specimens who are accustomed to tolerating a great deal of pain. They are also motivated: With those time-stamped contracts hanging in the balance, there’s a clear incentive to get back in the game.
Those factors rarely apply to ordinary people with back pain. Many of them have lost whatever level of physical fitness they might once have had, and aren’t inclined to follow an intensive physical rehab program when the allure of the sofa and a ready supply of post-op painkillers are so much more compelling. One study showed that in a pool of 725 patients with workers’ compensation claims for spinal fusion, only 26 percent returned to work in a two-year period. All too often, spinal fusion patients wind up on opioids and disability. Approximately three million Social Security Disability Insurance beneficiaries in the U.S. identify musculoskeletal disease — mostly back pain — as the cause of their incapacity, and that number continues to climb.
As an investigative journalist and the author of “Crooked,” a new book about the back pain industry, it’s my hope that the misfortunes that have befallen Steve Kerr and Tiger Woods will open the eyes of ordinary people who suffer from back pain to what can go wrong, surgically speaking, and to think again if they believe that surgery is their only option.
I spent seven years listening to ordinary people tell me how they started out with annoying but still manageable back pain and wound up in much worse shape. Since the book was published, my email and private messages sent to the book’s Facebook page have been full of tales of surgical carnage. Many people told me they chose surgery because they thought it would be a quick fix, insurance would pay for it, and if it was good enough for professional athletes, it was good enough for them.
Kerr had a frank message for people with back pain who might be considering surgery. “I can tell you if you’re listening out there, if you have a back problem, stay away from surgery. I can say that from the bottom of my heart. Rehab, rehab, rehab. Don’t let anybody get in there,” he said during an April 23 press conference.
Instead of initially seeking advice from a surgeon, who is likely to prescribe surgery, turn first to a physical therapist. Search the American Physical Therapy Association’s website for therapists with DPT or OCS after their names, identifying them as having received doctorates and orthopedic clinical specialty certifications. In addition, look to the American College of Sports Medicine’s ProFinder to track down a trainer who knows how to deal with back pain. Another option is to seek the help of a physician who specializes in physical medicine and rehabilitation. But be sure to ask questions — you want a clinician who delivers exercise, not injections.
We could also use some help from professional athletes: Instead of making recovery from back pain look so easy, could you please show us the work and grit it takes to get better?
Cathryn Jakobson Ramin is an investigative journalist whose efforts to resolve her own back pain led her to take a close look at the scientific evidence for what the spine business was selling, a journey described in “Crooked: Outwitting the Back Pain Industry and Getting on the Road to Recovery” (Harper, May 2017).