When medicine makes its own miracles

We live in incredible times and Tiger Woods’ recent return to golfing excellence is just one example of a reality that should make us take a step back and marvel at the pace of human achievement.

Woods has a back that’s left him crippled, and three spinal fusion surgeries didn’t help.

I know how this goes. Back in the ’60s, my brother had the same surgery. He was in the hospital for weeks, and then in a bed at home for about a year in his junior year in high school. He attended school using only a two-way speaker, carried from class to class down at the high school. He was unable to leave that bed.

The surgery, as it turned out, didn’t work. He missed out on the socialization that’s important in high school, his hunchback made him an easy target, and when he finally was free to go off to college, he couldn’t really handle the freedom.

So he worked in a factory until, like most factories in Massachusetts in the ’70s, it closed.

A string of health problems left him homebound until he died a few years ago.

So stories of medical achievement in 2019, like the New York Times’ report today on Woods’ breakthrough, cause both moments of celebration and bittersweet reflection.

Spinal fusion surgery removes a disc in the spine, along with the nerve-cushioning jelly, and fuse the remaining spine together. In theory, the pain disappears, but the patient has less flexibility in matters of the back.

From the sound of things, Woods’ surgery shouldn’t have worked. He shouldn’t have beeen able to return as a champion golfer. But he did.

Dr. Richard Deyo, an emeritus professor of medicine at Oregon Health and Science University, and his colleagues conducted a study in Oregon and found that about half of fusion patients who had the procedure on their lumbar, or lower, spine were using opioids before their operations. After their surgery, only 9 percent stopped using the drugs. And 13 percent who had not used opioids became long-term users after the surgery.

It’s hard to know what constitutes success, Dr. Deyo said. For example, one study, one of whose co-authors was Richard Guyer of the Texas Back Institute, who was widely reported to be Woods’s surgeon, reported a “clinical success rate” of 57 percent after two years. It defined clinical success as at least a 25 percent improvement in overall functioning, with no device failure, no major complications and no neurological deterioration.

Only knee and hip replacement is a more popular surgery than spinal fusion, the Times says. And it hints that Woods’ pain problems will likely return, but not before he gets a few more big paydays.

But these are what baby steps in medicine look like, and this is why the world of medicine provides something that few other avenues of life on terra firma provide: hope for the future.

  • Gary F

    And a left knee with little or no cartilage.

    It’s not just that he’s playing golf again, but he’s beating the worlds best golfers that blows me away.

  • Rob

    I wonder how many health plans would cover the cost of this surgery more than once. My guess is: none. Tiger’s wealth ensured that he could have the procedure done multiple times. So, it’s a medical miracle, only if you happen to be a 1%er.

    • I’m looking at my new Medicare medigap policy and there’s nothing in it that says you only get X number of the same surgery. And my group insurance health plan, which I’ll only have for two more weeks, does not have a limit on the number of surgeries to get something fixed right.

      • Rob

        GTK. Does the policy or plan specifically say that, in the event the first surgery isn’t successful, additional surgeries of the same type will be covered?

  • Guest

    THIS is the trade off in medicine for profit.

    Laparoscopic surgery using cameras in the knee instead of slicing it wide open was developed and first used for star football players who valued the quick recovery time. Now we all have it done,

    Expensive preliminary methods are tried out, without help from insurance companies, but if successful (and many are not) then we all benefit as it gets covered.

    I am betting the rate of spinal fusion, joint replacement, Lasik eye surgery are all higher in the for-profit US versus national health countries.

    This is why the vast vast number of medical advancements come out of the for-profit US health industry.

    • king harvest

      Both your premise and conclusion are seriously flawed.
      From the Wikipedia:
      “In 1901, Georg Kelling of Dresden, Germany, performed the first laparoscopic procedure in dogs, and, in 1910, Hans Christian Jacobaeus of Sweden performed the first laparoscopic operation in humans.”

      • Guest

        I don’t see that as changing either my premise or conclusion. Take a look at how often knee surgery was done since say 1970 via incision versus laparoscopic. Now a surgeon would have to explain why an incision is needed in this case.

        Even so, the whole point is about all medical advancements.

        • king harvest

          If your example is so incorect, it does tend to indicate that the premise is flawed.
          The number of times a procedure is done has no bearing on your argument. How many heart transplants have happened? A lot. Does that prove that the South African health system is superior to America’s?
          I believe the point you are trying to make is political and the only evidence offered is either incorrect or as vague as “all medical advancements”.

    • Jack Ungerleider

      Another issue with your discussion is that LASIK is not covered by most insurance plans as it is classified as an elective or cosmetic procedure. This is why you’ll see competitive pricing in ads for Laser Eye surgery clinics when discussing LASIK. The reduction in cost is purely market driven.

  • Al

    Thank you for sharing about your brother, Bob. Stories like his–in our own family and friends–are why many of us in public health and medicine keep pushing forward. The future will keep getting better.

  • AL287

    My twin sister had spinal fusion surgery at age 20. While the surgery cured her back problem, as she grew older bones spurs formed at the site of the surgery and have disabled her somewhat again.

    Additional surgery is not an option because there is a significant risk of paralysis.

    She is sometimes forced to use arm crutches and can have severe muscle spasms from nerve impingement from the bone spurs.

    She does not use narcotics but had specially compounded pills to help her deal with the muscle spasms as part of a clinical study that has now ended.

    She gets around and fights the frequent muscle weakness with special daily exercises. She is determined not to use a wheelchair.

    She teaches full-time at a small private school and has a private music studio.

  • Tyler

    This reinforces my belief that professional athletes have access to carefully tailored cocktails of pain medication that the rest of us don’t.

  • Kassie

    I’d be interested in the definition of “surgery” where the most popular are knee and hip replacement, then spinal fusion. For instance, abortion/D&C/D&E seems to not be considered a surgery. Vastetimaies outpace hip replacements. There are almost four times as many C sections each year than hip replacements each year.