Wednesday 29th November 2017
Harley Street Spine assesses the damage and the impact on his World Challenge performance
Tiger Woods has recently announced that he will be returning to competitive golf in time for the PGA Hero World Challenge 2017.
The news is in light of Woods’ absence from competitive golf since 2015 following a back injury which resulted in a series of surgical intervention and pain medication.
Initially, Woods began complaining of lower back spasms during his rounds whilst competing which previously impacted on his performance since 2015. However, it wasn’t until April 2017 that he announced that he had just undergone ‘successful back surgery to alleviate ongoing pain in his back and leg’. The announcement went on to explain that his bottom lower-back disc severely narrowed, causing sciatica and severe back and leg pain. The surgery involved removing the damaged disc and re-elevating the collapsed disc space to normal levels allowing the one vertebrae to heal to the other.
Tiger Woods recently underwent a practise round of gold with Patrick Reed, a former WGC Cadillac champion. Reed evaluates that ‘this time he was fully committed and fully trusting his body that there would be no pain. If he says healthy and his body cooperates the way it is supposed to, he’ll be back to playing golf, hopefully like he used to play”.
In light of the news, we have conducted a Q&A session with Mr Bob Chatterjee of Harley Street Spine and Highgate Private Hospital to determine whether Woods’ back will have recovered sufficiently to perform in the Hero World Challenge at his optimum level prior to any back injury.
Is lower back pain and even Sciatica a condition that is common for those who regularly or competitively play golf?
Almost certainly. A professional golfers swing can put significant strain on the lower back of a golfer. The lumbar disc is able to withstand compression well, but less able to withstand the twisting or torsion generated whilst creating a coil in the golfer’s upswing. The acceleration then unleashed in the downswing magnifies the generated torque applied to the disc causing repetitive injury to the disc.
Wood’s recent surgery involved removing the damaged disc and re-aligning the remaining discs. What method / technique would the surgeon have likely used to do this?
Tiger would have had a lumbar fusion done on this third occasion. The first two surgeries involved removing disc fragments that had burst free from his lowest lumbar disc and pressed upon the nerve. Although this was initially successful, the difficulty was that when you’ve lost disc material as a result of a slipped disc, the body has no way of regenerating the lost disc. Eventually this leads to thinning of the disc. The disc is normally a filler between two vertebrae. The loss of disc height means that the vertebrae move closer to each other. The nerve which normally leaves the spinal column via a route between the vertebrae then gets pinched as the vertebrae are now closer together. In this situation, the disc height needs to be restored and Tiger has had a metal hollow cage implanted between the vertebrae after the remaining disc was scooped out. The hollow cage contains artificial bone which eventually after a few months grows into the vertebra above and below therefore linking them together with living bone. The is called a ALIF (anterior lumbar interbody fusion). One big advantage to Tiger is that this is placed through a frontal approach to the spine, going by the side of the abdominal contents. This therefore avoids further damage to the muscles of Tiger’s back which were causing him spasms. It is interesting, that even though he was at a centre for disc replacement, a fusion was performed rather than a lumbar disc replacement, although in my opinion that was the correct decision.
Will Woods be able to perform to his optimum level as he did previous to this injury?
To a degree. The back never returns to 100%, but it doesn’t need to. With his swing coach, Tiger has reconstructed his swing to lessen the torque/twisting being applied to his lower back and is relying on timing as much as power. As Sir Nick Faldo once said ‘don’t hit it harder, hit it better…). Provided he is pain free and comfortable in his movements, he should be able to return as a serious contender. Although at his level of sport, the mental side of recovering from injury is as important.
Is there a likely chance that the injury could happen again?
Not at the lowest level, as the disc has been removed entirely. However, once you’ve had a disc prolapse in one area, the risk is slightly increased that it could occur again in another part of the spine.
What are the new methods/techniques that are currently available for an injury such as this?
There are newly available disc augmentation techniques that can be implanted into a disc. These implants then absorb water to swell the disc up to try to restore the lost disc height. They are injectable, so don’t involve major surgery, and early results from Germany are promising. But they need to be used before the disc degenerates too far.