By Dr. Michael Gordon
Patients planning for their minimally invasive spine surgeries have many
concerns, not the least of which include the nature of their surgery,
the risks and benefits involved, and the extent of recovery after surgery.
Patients are often concerned about the training and experience of their
surgeon, the quality of the hospital and nurses, the availability of rehab
facilities near their homes.
For most of my career, I’ve been a leading expert in minimally invasive
surgery in Orange County. In the last 15 years, over 95% of the lumbar
disk surgery and single level laminectomy and fusions I have performed
have been treated as outpatient at Hoag-Affiliated Hospitals in Newport
Beach and Irvine. We have a great staff and a highly professional, extremely
qualified group of doctors and anesthesiologists.
What About Life After Surgery?
In our active society, the follow-up question I hear most often is, “After
my surgery and recovery, when can I get back to golf?” Most patients
have false beliefs that after a disk surgery or a fusion, their athletic
careers are over. I’m happy to say that with modern techniques,
return to sport is mostly a “sure thing.”
With minimally invasive surgeries such as microscopic lumbar discectomy,
outpatient lumbar fusions, outpatient cervical fusion, and similar small
incision surgeries, the recovery time is surprisingly short. Because I
have been able to shorten the surgical times and risks, diminish the size
of the incisions in the neck and the lower back, and decrease the pain
and total time in the hospital, recovery time after surgery has been decreased as well.
Patients vary in their ability to return to sports after any surgery, and
this of course depends on many factors. For example, are you a professional
athlete or just a weekend warrior? Is your sport competitive professional
hockey or club tennis? Back at Johns Hopkins caring for players in the
Orioles organization, my professors used to say that, “Amazing bodies
have the potential for amazing recovery.”
*The photo above shows minimal scaring from a lumbar minimally invasive
*The photo above shows minimal scaring, a 2 inch incision from a minimally
invasive lumbar fusion.
Setting Yourself Up for Success After Your Procedure
After your minimally invasive surgery, how can you get back into action
as quickly as possible? First of all, be honest about your starting point.
Studies have shown that patients who lose a few pounds before their surgery,
stretch and strengthen their core, minimize smoking and alcohol consumption,
and get their medical conditions optimized do the best. So cut back on
the sweets and the fats, throw the cigarettes away and limit the cocktails
– it really helps. Obesity has been shown to increase complications
and length of recovery, so do your best to push away from the table!
Before any surgery, I carefully address my patients’ health. Consultation
with internal medicine, pulmonology, and cardiology may be necessary.
Controlling high blood pressure and diabetes is particularly important.
Before any surgery, I recommend limiting the use of supplements vitamins
as many of these can create unexpected or adverse reactions with anesthetic agents.
Getting Back in the Game: Professional Athletes
Many studies today show that most athletes return to their pre-surgery
levels of play after spine surgery. In a study of 22 young athletes undergoing
minimally invasive fusions for lumbar spondylolisthesis, 82% returned
to football, soccer, cricket, and golf. A summary of the SPORT study (Spinal
Outcomes Research Trial) performed by the North American Spine Society
showed that between 85% and 100% of athletes were able to return to their
pre-surgery level in professional sport after a minimally invasive lumbar
discectomy. The reported recovery period after lumbar discectomy ranged
from 2.8 to 8.7 months. The average career length after lumbar discectomy
ranged from 2.6 to 4.8 years. Elite athletes reached an average of 64.4%
to 103.6% of baseline preoperative statistics after lumbar discectomy
with variable performance based on sport. Even in twisting sports such
as baseball, these athletes did the best in recovery. Football players
stayed in the league longer, played more games and made more money if
they had surgery than if they were treated non-surgically. This is true
in hockey as well.
In the flagship study from the Professional Athlete Spine Initiative (PASI)
in 342 patients, players with a diagnosis of LDH from hockey, baseball,
football and basketball, successfully returned to play 82% of the time,
with 81% of surgically treated patients returning to professional play
for an average additional 3.3 years (remember the average career in football
is 4.5 years). After a fusion, a rehabilitation protocol beginning with
core strengthening and non-impact activity begins 2 weeks post-surgery.
During the first 3 months, all exercises are done with a neutral spine.
At 3 months, higher impact training may start and at 4-6 months sport
specific training begins. Athletes may return to play when they demonstrate
normal strength, normal range of motion and no pain with sport specific
activity; typically occurring at 6-12 months after surgery.
What if You Aren’t a Professional Athlete?
Don’t despair! I can still help! Obviously, different surgeries require
more time for rehabilitation before it is safe to return to sports. I
discuss some examples below.
For the smallest surgeries such as a microscopic lumbar disk herniation
surgery, patients can expect a week of limited activity. Then, the straight-ahead
exercises with a neutral spine can start under the direction of a physical
therapist. Bending, stooping, and lifting exercises can start in 4 weeks,
and twisting sports can begin at 8 weeks. In golf, chipping, putting and
irons are okay at 8 weeks. I recommend avoiding the golf range for at
least 4 months post-op because of the intense repetitive twisting motions
associated with hitting a driver.
For the slightly larger minimally invasive surgeries such as lumbar fusions
for spondylolisthesis, degenerative disk disease, or spinal stenosis,
the ability to perform twisting sports again takes more time. The forces
on the implants can loosen screws and cages if done too soon after surgery
so each patient has to be evaluated on a case-by-case basis. Running,
jogging, treadmill, elliptical, and swimming laps are usually possible
within 4-6 weeks. Again, those heavier activities are possible 4-6 months
after surgery. (Remember, the pros get paid to play—amateurs and
mere mortals do it for fun.)
For golfers, modifying the swing after surgery is very effective to help
prevent getting reinjured. Consult your golf professional for more help
with this. A shorter “modern” swing is advisable. Careful
attention to core strengthening is also a crucial part of recovery. The
hardest habit to learn is the 15 minutes of warm-up before play, and the
15 minutes of cool down afterwards. The daily sit-ups, crunches, planks
and balance ball
have to remain a daily event, not monthly. You couch potatoes know what I’m talking about!
There are always worries and concerns when planning any surgery. Thankfully,
with minimally invasive spine surgery in Orange County, modern techniques
have improved outcomes and decreased the pain and the risk of the operation
for countless patients in the area. Before you know it, you will be back
in the swing of things!