In April 2017, Tiger Woods announced it had undergone the fourth operation on its back in a little more than two years. At the time, Woods had not played in a major tournament in more than 18 months. Back spasms and related pain shooting through his leg had made it difficult for him to play with his two children or sit long enough to eat dinner at a restaurant. He didn't know how to play high-level golf again. The aim of the surgery, he said, was to recapture "a normal life" while giving him a chance to return to competitive golf and live "without the pain being so long."
completed the most stunning sports comeback in recent history, testified to the durability of genius and, perhaps most fundamentally, endorsed by the possibilities of modern back surgery. first leg saved
The moment that made Sunday's victory possible two years ago, almost to the day, at the Texas Back Institute Richard Guyer performed anterior lumbar interbody fusion surgery on Woods, fusing together his L5 and S1
Whether a patient is a weekend hacker or one of the greatest golfers of all time, ALIF is a last resort. "For a better term, it's a bailout procedure," said Stephen Banco, an orthopedic spinal surgeon at the Keystone Spine and Pain Management Center in Wyomissing, Pa. It has been used for more than 50 years and is considered routine. Its rate of success has risen so high that it is used as the control for other experimental procedures to measure against. But success usually means a patient recovers to the point of happiness, not athletic greatness. In the wake of Woods' masters victory, experts expressed shock at the extent of his recovery
"It's almost miraculous," said Jack Zigler, president of the International Society for the Advancement of Spinal Surgery. “On the one hand, you have somebody who's in great physical condition and extremely well-motivated – it's the ideal patient. But on the other hand, he's going back to an unbelievable level of function. The likelihood you could ever get back there is small. ”
Before Woods, the chances may have been nonexistent. Wellington Hsu, a professor of orthopedic surgery and neurological surgery at Northwestern University, has studied athletic recovery from spinal fusion surgeries. For golfers, he pegged the successful return after spinal fusion surgery as a "0 percent success rate."
Hsu has seen players return to the NBA, NHL and NFL with few problems. He used PGA Tour for Dudley Hart as a case study for golf. When Hart returned from spinal fusion surgery last decade, he could play well for two rounds, but had pain and soreness prevented him from stringing four rounds together at his previous level. From that example, Hsu came to believe the demands of golf after fusion surgery, which were greater than any other sport.
"It's nothing short of amazing," Hsu said of Woods's triumph. "I never thought having a lumbar fusion would be compatible with return to play in golf, and I'm just talking about returning to play at a high level, not winning the Masters at any stretch of the imagination. When he had done his surgery, I had a lot of questions about what his prognosis was. I was probably giving as bleak of a prognosis as anyone could, just to get back to the sport. ”Banco said he would have been told Woods to expect to be relieved of pain, and to get back to a normal life, but a normal life without, say, winning the Masters.
"I get people back to golfing, but these are amateur golfers that want to play once or twice a week," Banco said. “This is a guy competing at the highest [level] four days in a row. It's remarkable that he did it. That's all I can say: It's absolutely remarkable. I would have never given him a chance. ”
Woods came back from a number of personal and physical travails: the public exposure, and attendant humiliation, of rampant extramarital affairs; a reported obsession with Navy SEAL training that diminished him physically; thorn ligaments in his knee; prescription drug addiction treatment spurred by a DUI judgment; The toll age extracts from any great athlete.
For all Woods, it was his fourth back surgery that unlocked the possibilities on display at Augusta National. At one point before he turned 40, he once remembered in a time interview, Woods collapsed outside his home and had to wait until his daughter found him lying there. "Sam, thank goodness you here," he told us here. "Can you go tell the guys to try and get the cart out?" On Sunday, at 43, Woods beat the world's best golfers and hoisted his son behind the 18th green in celebration.
Woods said Sunday, "I could actually swing a golf club again."
A significant procedure
The spine can be seen as a tower of building blocks with cushions in between. The blocks are vertebrae, and the cushions are disks Trouble comes when a disk tears or breaks internally.This can cause a piece of disk to push against a nerve, which leads to sciatic pain firing into a leg. strikes.
Woods had a disk problem, most likely, in 2015, Woods underwent three operations, the first two of which were discectomies – shaving down a disk to prevent it from bulging against a nerve Those surgeries provided only temporary relief He left the disk eventually left him in shock absorption. The torque applied by a golf swing would have caused the intense pain he felt in ALIF is what saved Woods's career? Those initial operations, experts said, were not mistakes. ALIF is considered a more drastic measure, with less chance of allowing a top-level golfer to return to his best shape.
"Any time you deal with a golfer, especially a professional golfer, lumbar fusion is the absolute last treatment option you're willing to consider, ”Hsu said. “We really don't have a fashion of success for these kids of procedures. That's why surgeons were chosen to be as conservative as possible for as long as possible. ”The disk afflicting Woods was the cushion between the lowest lumbar vertebra (L5) and the highest vertebra in the sacrum (S1). The sacrum is a large, triangular bone that anchors the back of the pelvis.
If Woods had any good fortune, it was that of any disk to derail his career, it was the one between the L5 and S1. At that level, the pelvis still provides protection, and the location takes less than higher levels of the spine.
"If you are going to have single-level fusion, the bottom level is the best place for it to "Guyer said in a statement on Woods' website announcing the procedure in 2017." Some people were born with one less vertebrae, which would have been similar to someone who had a single-level fusion. "(On Monday, TBI Chief Development Officer Cheryl Zapata said the institute could not confirm or deny Woods had been a patient, let alone make Guyer available for an interview, despite his prior comment.] The surgery can be described through each letter of the acronym.
Anterior: where the incision happens. Guyer would have sliced Woods open at the front of his body with a small incision, moved behind his abdominal muscles and pushed aside his bowels without disturbing them.
Lumbar: The surgeon operates on the lower spine, as opposed to the upper (cervical) portion of the spine.
Interbody: Between bones – in this case, the two vertebrae
Fusion: Guyer would have actually turned two into one, in the process removing the disk causing so much pain.
First, the surgeon removes the problematic disk . Next comes the fusion. When a surgeon fuses together, the goal is to trick them. The body's natural mechanism for heal bones is also the best method. A surgeon will clean the ends of the vertebrae to create bleeding, which prompts the body's natural reaction.
The vertebrae are grafted together with a substance from outside the body. In the early days, a surgeon would have used a piece of bone taken from the patient's pelvis for the graft. It worked great but also a longer recovery – sometimes a week-long hospital stay.
Doctors transitioned to bones from cadavers, which are still used, but rarely so. Typically, the bones are fused with titanium or high-grade medical plastic, often with two screws on the S1 side and one screw on the L5 side. The hardware itself will not sustain the fusion. The material will be filled with something to promote bone growth – pieces of bone from a cadaver, bone cells or synthetic protein.
Essentially, Zigler said, the surgeon is creating "living rebar."
An ongoing challenge  Raymond Hah, assistant professor of clinical orthopedic surgery at USC's Keck School of Medicine, is a spinal surgeon and a recreational golfer. He finds Woods's performance inspiring for both reasons. He could see Woods adjust his swing after surgery, "trying to accommodate his new anatomy," Hah said. Hah said, "Hah Marveled at Woods’s resolve." “I don't know if there is a great medical perspective on it, other than it is a pure testament to his ability and his mental toughness.”
Moving forward, Woods will require maintenance and, more importantly, discipline to avoid a heavy schedule. Woods has said he will play fewer tournaments this season, and surgeons agreed that is wise. The surgery places Woods at risk in the future. Data suggest people who have undergone fusion surgery will see the level above their fused vertebrae – in Woods case, the L4-L5 – wear down quicker than the natural aging process.
"You look at his swing speeds, [and] you Got to worry about the longevity of the next level of his spine, ”Hah said. "As I see it, I would say there is some concern there." Banco said the risk of increased degeneration is about 30 to 40 percent for an average person, but for a professional golfer placing excess torque on his lower spine.
"I wouldn't underestimate him," Banco said. “We have no data to support that, because he is so far outside the standard deviation.”
The dramatic success Woods experienced may be other sufferers of back pain to consider surgery. Zigler cautioned against that impulse. He said 95 percent of people do not need back surgery, and the other 5 percent need to go through structured, more conservative care first.
“I would count the average golfer, do not extrapolate this to your situation,” Banco said. . “I would say 99.9 percent of people need a little bit of physical therapy, because they're out of shape.”
Still, Woods provides a success story. "This is something nice for us to point two," Hah said. “People can really have a high level of function and have a quality of life. Sometimes the perception is not that. ”
Woods’s victory was inspiring in many ways. "We don't expect everybody to go out and win the Masters," said Zigler. "But it looks like it's possible."
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