On January 30th, 2015, Tiger Woods shot his worst professional round ever and missed the cut at the Phoenix Open.
The once dominant golfer who won the 2013 PGA Player of the Year is ten months removed from a lumbar microdiscectomy. And on that late January Friday, he appeared decidedly mortal.
Two days later, on February 1st, 2015, Patriots tight end Rob Gronkowski caught 6 passes for 68 yards and a touchdown to help his team win Super Bowl XLIX. Nineteen months earlier, he underwent a lumbar microdiscectomy to relieve pressure from a herniated disc. He was back on the field within four months and led all tight ends in receiving last year (despite missing training camp while recovering from a torn ACL).
Two world class athletes, two very different stories.
A discectomy is traditionally the option of last resort for herniated disc sufferers. In this procedure, surgeons remove the herniated part of the disc to relieve pressure on the nearby nerve. The microdiscectomy version, chosen by both Woods and Gronkowski, is performed with an endoscope thus allowing smaller incisions, less muscle retraction and generally minimizing trauma to surrounding tissue.
Gronkowski’s 2013 procedure was actually his second microdiscectomy. At 25 years old, he is in fantastic shape and has shown a remarkable ability to quickly recover from numerous injuries. Most people considering back surgery however, are older, and it’s safe to say that most of us aren’t genetic marvels like Gronkowski. Woods is 39 years old and despite being physically fit, his recovery has been markedly slower with many beginning to wonder if the years and injuries have finally taken their toll on his career.
Like any surgery, especially spine-related, microdiscectomy comes with risks and there are no guarantees of success. In addition to potential complications from anesthesia, microdiscectomy procedures can result in dural tears (cerebrospinal fluid leak), nerve damage, and infection. Additionally, 5%-10% of patients develop a recurrent disc herniation at some point in the future.
From 2000-2004, a randomized clinical trial called the Spine Patient Outcome Research Trial (SPORT) was conducted using 501 lumbar herniated disc patients over 13 multidisciplinary spine clinics in 11 U.S. states. Half were randomly assigned surgery while the other half were assigned therapy. In both the surgical and non-surgical cases, patients generally reported more relief from radiating leg pain than from lower back pain itself. And while the surgical patients were discovered to exhibit marginal improvement over the non-surgical patients for the first and second years after the study, those differences decreased as time went on with some patients requiring additional surgery.
For patients without insurance, physical therapy can cost anywhere from $50 to $300 per treatment session. Microdiscectomy, on the other hand, can cost anywhere from $15,000 to $100,000. Costs for patients with insurance will vary depending upon coverage, of course.
None of this is meant to imply that non-surgical treatment is always preferable to a microdiscectomy. In fact, microdiscectomies are fairly common and, usually for good reason: many patients will benefit from the surgery in a way that they simply would not benefit from alternative treatments.
Surgery should never be undertaken lightly. And a second opinion ensures you receive the right surgery for your condition and unique circumstances.
Rather, the point is that the decision to undergo surgery should never be taken lightly. Multiple factors should be considered including the financial cost, time, risk, rate of recurrence and—most importantly—your own unique conditions.
Gronkowski and Woods are two different men who underwent similar procedures with different results. In both cases, we would expect that they received multiple opinions, top notch care and that—ultimately—the surgeries they underwent were likely the appropriate ones for their circumstances.
We all have differences – age, job, sex, health, recreational activities, injury history, pain tolerance, etc. Each patient and their circumstances are unique and should be thoroughly reviewed before a treatment is decided upon.
Before deciding on your course of action—particularly one that involves surgery—it’s always best to consult a physician and to get a second opinion.