Spinal Surgery

As many of you know, I am an avid sports fan.  This week, a story shed some light on Steve Kerr, coach of the Golden State Warriors, and his experience with failed back surgery.  A little information on Kerr, he played professional basketball for several years and is a six-time NBA champion.  He has been the coach for the Warriors since 2014, where he has lead them to one championship and is favored to win a second this year.  In 2015, Kerr opted for spinal surgery for an undisclosed condition.  This surgery caused a leak of cerebrospinal fluid, which is the protective fluid surrounding the brain and spinal cord, which sent Kerr for a second surgery to fix the damage from the first. 

This story is making headlines now, because Kerr has experienced so many complications from surgery that he has missed several playoff games.  His current symptoms include severe neck pain and migraine headaches.  He has dealt with these symptoms since surgery, and has been suffering from a particularly bad flare-up.  In a recent interview, Kerr gave his thoughts: 

The symptoms, for whatever reason, took a turn for the worst maybe five days ago.  I was able to manage the pain and discomfort over the last year and a half, and suddenly things got a lot worse and I don’t know why… …I can tell you, if you’re listening out there, if you have a back problem, stay away from surgery. I can say that from the bottom of my heart.  Rehab.  Rehab.  Rehab.  Don’t let anybody get in there.”  

Spinal surgery remains an important medical tool, however I believe it is used too often and without clinical indication.  Fusion surgery, the most common type of spinal surgery, was originally developed to treat catastrophic spine injury, such as vertebral fracture.  This is a surgery that is vital to current medical practice and helps many people in drastic need of immediate relief.  The trouble comes when fusion surgery is used for something else.  

At some point in the 1980s, the number of spinal fusion surgeries performed exploded due to the use of fusion to correct for degenerative disc disease.  There are a number of reasons why spinal surgery should not be considered for degenerative disc disease.  Most importantly, degenerative disc disease is not always a cause of low back pain.  In a study done by the American Journal of Neuroradiology, 3110 asymptomatic individuals were given an MRI to evaluate findings.  The results showed that prevalence of degenerative disc disease increased from 37% in 20-year olds to 80% in 50-year olds to 96% of 80-year olds.  Now it is true that having degenerative disc disease could make you more likely to have back pain, how could it be a definitive indicator of the cause of low back pain if this many people could have this disease without symptoms?  

Of course, I would never recommend spinal surgery unless everything else has tried and failed first.  A conservative approach to fixing pain should always be taken first due to the many risks involved with spinal surgery. I’m sure Steve Kerr would agree. 

Yours in Health, Dr. Alex