How artificial disc replacement keeps golfers in the game.

Modern ADR technology and medical methodology can solve back and neck pain without ruining your swing.

You can tell who the passionate golfers are – the people who take the game seriously. Just about anyone with a minimal amount of training can look great stepping up to the ball. But their swing will tell you everything you need to know about how much practice a person invests into their game.


Some golfers have that power swing that can knock a ball down the fairway 300 or more yards then switch to the slight gentle swing that lets them putt a ball into a hole 30 yards away. And for the rest of us, we can stand back and marvel at their skill. However, all that control and strength comes at a cost. The initial cost is the swing itself, which puts a great deal of stress on all of the components of the spine. Another cost comes from repetitive practice needed to achieve muscle memory so that each swing is as identical and predictable as possible.


Visualizing the cost requires some idea of how the spine is constructed. There’s the spinal cord that runs down the center of your back and ends at what we call “L1” or the lumbar 1 level. From there the spinal nerves run down the rest of the way through the lumbar portion (low back) of your spine to the tailbone. Then there’s the column of bones, called vertebra that protects and guides the spinal nerves to the base of the pelvis. The nerve roots extend out of the spine into the rest of our bodies and extremities (arms and legs).


The bones of the spine are also the central load-bearing structure of the skeleton. Here you find the key anchor points for nearly every muscle a golfer needs to pop a 45.9-gram regulation golf ball down the fairway. Between the vertebra bones are flexible sponge-like discs that cushion load stresses as they help hold the structure of the column. The discs also work in concert with muscles and tendons to prevent hyperextensions, hyperflexions, and hyperrotations that could damage the integrity of the spine. And it is these discs that often wear out and fail.


Among golfers, the most common disc failure (e.g., herniation) is in the lumbar region (lower) of the back. Persistent ache is the first symptom that one or more disc herniations are in progress. Usually, as the disc loses its shape and some disc material may literally squeeze out and compress a nearby nerve. As the “cushion” loses integrity, bone spurs may grow, or parts of the vertebrae may compress nerves.


When discs become herniated, there are many ways that a nerve may be compressed and cause pain in the neck or lower back after a day on the course. An early visit to a doctor can lead to non-surgical solutions like physical therapy, muscle strengthening, and retraining. We can also turn to minimally invasive surgeries like microlaminotomies (which remove a few millimeters of bone) or microdiscectomies (to remove protruding disc material).


Unfortunately, too many golfers fall into what I call the “fusion box.” By the time many of them see a doctor, any disc herniations will have progressed to the point where there are few options left. Some doctors still feel that in these cases the only viable solution is spinal fusion surgery


What this means is that the doctor will cause two or more of the vertebra in the lower back to become one bone. The procedure is achieved one of two ways: by surgically installing steel rods and screws to stop the affected vertebra from moving; and another by installing a plate and screws in the front of the vertebral body and disc space itself. A bone or synthetic graft is added between the vertebra that grows and fuses with nearby bone and causes them to become a single solid bony structure.


I have a big problem with that approach, especially for golfers (or any athlete) who want to be as active as possible even after surgery. By fusing just one pair of lumbar vertebrae (one level), the patient immediately feels limits in their range of motion. I estimate 5-10% change in the full range of motion for every pair of vertebrae that are fused. That’s a massive change for an athlete who depends on a learned swing, let alone the practical changes in daily life.


But there’s an even greater danger for resurgery. Any athlete, even ones recovering from two-level lumbar spinal fusion surgery (imagine 10-20% change in your full range of motion), introduces a significant imbalance of pressure that’s transferred to the discs above and below the fused level. What we now know as adjacent disc failure is how the change of spinal fusion increases the likelihood of subsequent postoperative herniation. And there’s your box.


Spinal fusion leads to adjacent disc failure, perpetuates the cycle of pain and more surgery. Eventually, the active golfer can’t swing the clubs. And if the athlete doesn’t stop playing altogether, they limit their activities to the putting green.


Tiger Woods is one exception to this observation. He’s back in the news recently after winning the Masters Tournament this year. Several years ago, Woods had three lumbar discectomy surgeries, culminating in a fourth surgery, called anterior lumbar interbody fusion (ALIF). This was the correct surgery for Woods. As I understand it, he was not a good candidate for artificial disc because of previous surgeries and other physiological characteristics that are unique to him. His surgeon is a well-known ADR surgeon and certainly would have performed one for Woods were it appropriate to maintain natural flexibility and mobility. However, the single-level fusion was quite successful for Woods and it is wonderful to see him back in action once again.


With modern artificial disc replacement surgery, we have the technology and medical methodology not only to keep you in your game but also to help you improve. Artificial discs mimic the movement function of healthy discs. New disc technology is doing an even better job of imitating the anatomic structure of a natural disc – not only are we covering lateral and flexor movement, but some discs compress like a natural one.


By replacing discs rather than fusing vertebrae, we maintain a full range of motion. Some golfers are back on the course within 6 weeks of their surgery, enjoying painless activity. And a painless swing leads to better confidence on the course.


If you play a lot of golf, you are at higher risk for chronic back pain from a herniated or degenerated disc. Eventually, you may need back surgery. No matter if you are just an occasional player or an “A” list pro like Tiger Woods, being told that you need back surgery is not welcome news. You need the full natural range of motion of your spine. Even a single level spinal fusion will take away some of that range of motion. Artificial disc replacement surgery will let you keep your full range of motion, and it can also help prevent the need for future operations.


All it takes is a decision. Make it decisive and be greater than better.

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