Tiger Woods Back Surgery – From Disk Removal to Spine Fusion

How Might a Golfer Develop Back Issues?

Tiger Woods has unfortunately had to experience the unpleasant reality that low back issues can become a chronic condition requiring multiple surgeries.

A certain percentage of patients undergo multiple operations due to degenerative disease of the lumbar spine. Many factors can contribute including extent of pre-existing disease, lifestyle, occupational requirements, and possibly genetics. Competing in PGA tour events, the repetitive motion of hitting golf balls, is likely to have been a factor contributing to Tiger Woods condition.

Tiger’s First Back Surgery

In 2015 Tiger Woods underwent his first lumbar microdiscectomy procedure.

A microdiscectomy is intended to remove a “pressurized disc fragment”, a displaced fragment that is compressing and irritating a spinal nerve, aka a herniated or slipped disc. The intervertebral disc can be considered the “cushion” between the vertebrae or spinal bones. The outer wall of the disc can weaken over time, leading to cracks or fissures that allow the internal contents to escape and invade the nerve channels. Compression of these spinal nerves leads to symptoms, that can include pain, numbness, or weakness, specific to the area supplied by the nerve.

What Happens When a Nerve Gets Pinched in the Lower Back?

This syndrome is commonly referred to as sciatica, but the medical term is known as a radiculopathy.

Through a minimally invasive approach, using a small incision less than an inch in length, a spine surgeon can safely expose the spine, locate the nerve channel, and take out the pressurized disc fragment.  This leads to release of the spinal nerve and improvement of symptoms.  Often times, patients feel better, are on their feet the next day and make a full recovery.

Tiger Woods’ Back Surgery in 2017

In April 2017, Tiger Woods underwent a spinal fusion, as his persistent complaints not only compromised his ability to perform at an elite level, but very possibly his routine lifestyle.

At some point, continued degeneration and repeat surgery can compromise the mechanical structure of the disc and associated vertebrae. This is one indication for lumbar fusion – a procedure in which the vertebrae are locked together with various implants, typically a set of screws connected by rods. The implants provide immediate stability with the intent to have bone bridge across the vertebrae to form the long-lasting bridge, the fusion.

Lumbar fusion surgeries are more involved, with success not only tied to the release of compressed spinal nerves, but also the adequate healing of bone across the involved vertebrae. Limitations of movement can occur due to the joining of vertebrae that were meant to move independently. If the bones do not heal together adequately a patient can develop recurrent pain due to failure of the fusion, a pseudoarthrosis. Revising the fusion may be necessary under such circumstances.

Tiger’s 5th Back Surgery

This past December, Tiger Woods underwent his 5th spine surgery and 4th microdiscectomy. If his prior fusion has healed successfully, it is possible that he has developed what is known as adjacent segment disease.

A concern following a fusion is the transfer of stresses to the remaining mobile segments of the spine. This transfer of stress can accelerate the degenerative process at other sites, ultimately leading to more symptoms, known as adjacent segment disease. The segment next to the fusion becomes symptomatic. There is no standard of care regarding the treatment of adjacent segment disease, with possibilities including conservative care, performing the less invasive microdiscectomy, or extending a pre-existing fusion across the newly symptomatic segments. Factors involved in the treatment decision-making include what is supported by the literature, the experience of the treating physician/surgeon, and the wants/desires of the patient. A comprehensive assessment of the patient’s condition and advanced imaging is required to formulate an appropriate treatment option.