Tiger Woods endured six separate spine surgeries from 2004 to 2024. He is a professional athlete in peak physical performance. How is that possible? In my spine deformity practice I have performed surgery on patients with anywhere from one to 19 previous surgeries from other surgeons. Why would anyone — especially a healthy athlete — need so many procedures?
First, the spine is complex. Anatomy is critical. The spine is actually 33 bones stacked together by joints and cushioned by a soft-shock absorber called the intervertebral disc. Together this serves as a suspension bridge protecting the spinal cord as it brings the nerve messages from the brain to the rest of the body. Over the years, just like the suspension bridge, portions of the spine can wear out.
It’s possible that a problem gets fixed at one level and then a new one develops at another. It’s also possible that a patient needs another surgery at the same level of the previous operation.
One of the more common spine surgeries is a discectomy. Woods had this surgery multiple times. The surgeon removes a small portion of the disc, or shock absorber, that has squirted out and is pushing on a nerve and causing pain. It’s like the jelly coming out of a doughnut except that it’s human tissue, and the human jelly is pushing critical nerve fibers. When a surgeon performs this surgery, he or she doesn’t remove the entire disc. He or she only removes the portion that has squirted out. The chance of the disc herniating again is around 5%, and it usually happens in the first six weeks before the scar tissue has a chance to form. This is why we often tell our patients to avoid the BLT (bending, lifting and twisting) immediately after surgery.
Another common spine surgery is a fusion surgery, when a doctor places different types of instrumentation, such as rods, screws, plates or cages, for the bone to heal together at one or more levels of the spine. This is a more intensive surgery with specific indications. Woods had it performed in 2017.
The challenge with a fusion is making sure the bone heals. When it doesn’t, this is called a pseudoarthrosis, which causes pain. The idea of the instrumentation in spine surgery is to form an internal scaffolding for the bone to grow or heal. If the bone doesn’t grow around the instrumentation, it will eventually move, break or cause pain. This may result in the need for another surgery.
It’s important to realize that any type of spine surgery, especially fusion surgery, alters the biomechanics of the spine. Fusion surgery changes how forces are distributed to the levels above and below because certain parts become more rigid. This adjacent segment disease, or problems at the level above or below another surgery, can occur in up to 20% of patients over 10 years. That doesn’t mean every patient needs surgery, but it’s always a consideration.
The final and most difficult part for the surgeon is getting the spine’s alignment or overall position correct. We want our patients to stand up straight. The spine bones are not joined in a simple straight line, but rather in a complex collection of the correct amount of sway to the front (kyphosis) and to the back (lordosis), a large majority of which depends on the spine’s connection to the pelvis.
Spinal surgeons meticulously measure angles in the spine as well as the hips and pelvis and even knees to get the body’s alignment correct. In fact, the large majority of current spine surgery research and product development are focusing on the issue of getting the patient’s alignment correct. If the patient is grossly in malalignment, they are miserable. They can’t stand up straight. But if the alignment is even just a little bit off the patient is at a significant risk for another surgery due to biomechanical stress. A leading article in the journal Neurosurgery illustrated this in 2017. If a surgeon gets the spine alignment right, the chances of the patient needing another surgery are 6%. If the surgeon can’t get within a 10-degree angle of being correct, that number jumps to 75%.
I’m obviously not aware of the direct nuances of Woods’ cases. But it’s critical to understand spine surgery comes on a spectrum. It’s always a serious surgery, but the outcomes can be incredible. Spine surgery dramatically helps people who go on to live normal and functional lives. Woods won The Masters in 2019 after his fusion. American hero Astronaut Michael Collins had spine surgery on his neck in 1968 before he went to the moon in 1969 with Apollo 11.
Still, it’s important to realize, for most spine pathology, surgery is the last option. Back pain is a common problem; 40% of patients experience back pain each year and over 13% of patients have chronic back pain lasting greater than three months. But, surgery is absolutely not needed in every case. The indications for surgery specifically for back pain are very tight.
So how does the average patient avoid surgery?
Take care of your body.
This starts with lifestyle modification. This includes weight loss, spine specific exercising, and a proper diet. Anti-inflammatory diets low in sugar or refined carbohydrates can help reduce both weight and inflammation. Weight loss means the joints and disc will have less stress on them. Exercising helps, especially aquatic therapy and swimming because it reduces the axial load or weight shared on the spine joints during motion. Stretching can improve flexibility, and core strengthening exercises can build the muscles needed to help with posture. Be careful looking down at your phone all day as that can irritate your neck muscles and distort your body’s natural alignment. Try to stay in a neutral position, as opposed to slumped forward, while you are sitting at your desk. Bend with your knees when you are lifting heavy objects. If something hurts or aches that’s your body’s way of telling you to reduce that position of activity.
Patients should have some peace of mind. Due to the dedication of surgeons, researchers and patients, spine surgery has made tremendous improvements in the last 20 years. It’s safer than ever and getting better, and this progression has lead to solid life changing outcomes for patients of all athletic abilities.
