Posts

spinal fusion for back pain

Can Spinal Fusion For Back Pain Help You Play Golf Like Tiger Woods?

Understanding the Back Pain Treatment that Propelled the Pro Golfer to a Masters Win

For his recent victory at the 2019 Masters Tournament, which many sports commentators are calling one of the greatest career comebacks of all time, Tiger Woods owes a lot of credit. First, of course, to his own tenacity, discipline, and skill. But the 43-year-old golf legend also owes a debt of thanks to the spinal fusion surgery he underwent two years ago.

Woods, who hadn’t won a major tournament in 11 years, notoriously suffered from debilitating back pain throughout the past decade, pain apparently caused by a slipped or ruptured disc in his lower spine. Three earlier surgeries failed to correct the problem, or at least to ease his pain enough for him to resume training for major tournament play. Finally, in April 2017, he underwent anterior lumbar interbody fusion, commonly known as ALIF or spinal fusion.

For half a century, ALIF has been a widely accepted treatment to replace the disc that joins the lowest of the five lumbar vertebrae to the highest of the sacral vertebrae – what doctors call the L5/S1 region. It’s an area in the lower back where sports injuries are common, especially from the torque a vigorous golf swing inflicts on the spine.

Doctors typically cite spinal fusion to treat L5/S1 pain only after other treatment options have been exhausted, but at least it’s a surgery that offers little disruption of tissue, a fairly short recovery time, and a strong likelihood of returning to a normal, active lifestyle. It clearly helped Woods get his swing back. But is it right for you?

Other back pain treatment options

Spinal surgeons often consider ALIF a last resort. There are other, non-surgical and conservative measures for those suffering back pain due to a damaged L5/S1 disc. Spinal fusion is often reserved for patients with a deformity or lack of stability due to disk degeneration, trauma or infection, and according to Dr. Michael Shen, a Denver surgeon who specializes in neck, mid-and lower back treatment, it may be used for patients with a diagnosis similar to Wood’s, but only after other options are explored.

Many L5/S1 patients can also decrease their pain and improve mobility through physical therapy. A regimen of simple exercises – just a few minutes a day spent doing knee-to-chest stretches, pelvic tilts, leg lifts, and wall squats — can help herniated disc patients strengthen their lower spines.

“I work with each patient to exhaust non-surgical solutions to their spine pain before we explore any kind of surgical solution.” says Dr. Shen. “These options include physical activity and exercise therapy, pain management through medication, and microdiscectomy.”

Woods had two of those (microdiscectomies), which removed disc fragments that were pinching his nerves. Eventually, however, he and his doctors felt it necessary to remove and replace the entire L5/S1 disc, via ALIF.

What happens during spinal fusion surgery?

ALIF is a more aggressive treatment, but it may be the right choice if you’ve already had other spinal surgeries, or if you surgeon wants easier access to the L5/S1 area. While spinal fusion does weld two of the patient’s vertebrae together, it does so on the theory that removing the damaged disc will remove the source of the pain, and that diminished pain allows for increased mobility.

One advantage to ALIF is that it’s a minimally invasive procedure. For one thing, as the “anterior” in the name suggests, the surgeon approaches the spine from the front of the body. He or she goes through the abdomen, through an incision only three inches long, and is able to reach the spine by pushing aside muscles, organs, and blood vessels, rather than having to cut through them. A vascular surgeon may assist your orthopedic surgeon in gaining safe access to the spine.

The orthopedic surgeon first removes the herniated disc, then fuses the lumbar and sacral vertebrae together with an artificial disc made of titanium or high-grade medical plastic. This piece is called a spacer or an interbody cage. Sometimes the doctor will bolt this cage into place, but what really makes the two bones grow into one is a core of bone graft matter inside the cage, which fools the vertebrae into fusing together over the next several weeks, like a broken bone healing. The surgery itself takes only two to three hours.

Because the ALIF procedure is not very invasive, recovery is fairly quick. In fact, the patient is encouraged to stand up and walk the same day and is usually discharged from the hospital by the end of the third day. Full recovery can take several weeks and may include basic walking exercises, but no bending, heavy lifting, or back-twisting.

Can ALIF help you play golf like Tiger Woods?

Um, no. In fact, it’s remarkable that it even helped Tiger Woods play like Tiger Woods. Doctors have marveled that ALIF didn’t just ease Woods’s back pain but also allowed him to play major tournament golf for four straight days. As Northwestern University orthopedics professor Wellington Hsu recently told the Washington Post, even pro football, basketball, and hockey players are more likely to return to professional, competitive play after ALIF than golfers are.

Even for an athlete as extraordinary as Woods, with incredible stamina and drive, the prospect of playing major tournament golf again after spinal fusion was slim to none. Nevertheless, Woods returned to training within 10 months of his ALIF surgery, and nearly two years to the day after the operation, he won the Masters.

If you’re not a pro golfer, though, spinal fusion is much more likely to help you return to a normal, active lifestyle. Indeed, the surgery is so routine, and its success rate so high, that it’s considered the control against which researchers measure more experimental treatments.

Is ALIF the right option for treating your lower back pain? Schedule an appointment with one of our orthopedic spinal specialists to discuss the best solutions for you.

Best Spine & Pain Doctors

Christopher D'Ambrosia, MD

Dr. Christopher D’Ambrosia


Michael Shen, MD

Dr. Michael Shen


Back Pain Waiting in Line

5 things you are doing during the holidays to cause back pain, and how to fix them

Holiday Back Pain

Four out of five people will experience back pain during their life, and stress, fatigue and physical exertion during the holidays can quickly bring on the bah humbugs of lower back pain. Here are five seasonal challenges and tips to help keep your back in line this winter:

  1. Standing in lines. Whether it’s grocery shopping for big holiday meals, finding that perfect gift, or waiting in airport security areas, standing in long lines is one of the lesser joys of the season. How you stand makes a big difference to your lower back. Keep your weight on the balls of your feet, ensure that your knees are slightly bent, and keep feet shoulder width apart. Standing straight and tall can be difficult when you feel the defeat of holiday shopping or travel but don’t make the excursion worse with poor posture.
  2. Sitting too much. It’s been said that sitting is the new smoking. Our bodies are designed for activity. Sedentary behavior – including hours on the couch, at our desk, or in the car traveling – wreaks havoc on our muscles and reduces flexibility. Too often it becomes a vicious cycle: back pain leads you to shut down all activity and, with a body that’s built for movement, extended sedentary time leads to further complications (muscle atrophy, stiffness, loss of flexibility). Limit continuous sitting by building breaks into your day or try a standing desk.
  3. Long hours at work. How you sit at work matters. A lot. Good ergonomics go a long way towards back pain relief and prevention. Good desk habits include uncrossing your legs, using a chair with lumbar support, getting up and moving routinely and doing some basic exercises to help stimulate your muscles. Try sitting on a balance ball or using a standing desk, both of which help you to engage your core and take pressure off your back.
  4. Shoveling snow. Work and bills aren’t the only things that pile up during the holidays. Even though it’s been relatively dry this year, we all know is coming! Snow removal can directly lead to back pain. When you shovel, use your legs and lift with your knees, not with your back. This is especially important the closer you get to completion. As we tire, our form often suffers and that’s where back strain and pain occurs
  5. “Tech” Posture. Cellphones and laptops are a year-round challenge but we’re online now more than ever with 30 days of shopping – mostly spent on a laptop or ipad with questionable posture. An easy tip to ensure that you are in spine-friendly posture, is seeing if your ears are in line with your shoulders. If your ears are ahead of your shoulders, you are straining your spine. With poor posture, it’s only a matter of time before that strain and stress translates into back pain.

The spine is comprised of bones (vertebrae) and cushions (disks) that support all of your upper body weight. Our bodies’ natural movements make the spine subject to mechanical stress and pain – problems that increase with age and wear, and are exacerbated by certain repetitive movements. The result is bones pressing against nerves and causing pain.

These tips can help your keep your back and holidays in line, but if you’re already experiencing back pain, reach out to one of our spine specialists for help! Let’s put the cheer back into the holidays and keep the pain limited to travel and shopping.

Spine Specialists

Dr. Christopher D’Ambrosia

Dr. Christopher D’Ambrosia

• Interventional Pain, Spine, Sports
• Electrodiagnostic
• Rehabilitation Medicine


Dr. Michael Shen

Dr. Michael Shen

•Conservative and surgical treatment of neck, mid-back, and lower back disorders
•Minimally invasive/microscopic surgery
•Motion preservation technology