January 2017

 In 2014, Tiger Woods had his first lumbar micro discectomy. What is the most likely lumbar level(s) the surgery was performed at?

A. L1-L2 and/or L2-L3

B. L2-L3 and/or L3-L4

C. L3-L4 and/or L4-L5

D. L4-L5 and/or L5-S1

Scroll down for answer and details.

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In 2014, Tiger Woods had his first lumbar micro discectomy. What is the most likely lumbar level(s) the surgery was performed at?

A. L1-L2 and/or L2-L3

B. L2-L3 and/or L3-L4

C. L3-L4 and/or L4-L5

D. L4-L5 and/or L5-S1

 

The most common levels for a disc herniation to occur are at the L4-L5 and/or L5-S1 disc levels.

 

Dohrmann et al 2015

  • Evaluated the literature in 2015 for all subjects who underwent an operation for lumbar disc herniation.
  • Of 39,048 subjects, the most common level of disc herniation was L4-L5 and L5-S1, respectively.

 

lofldh

 

The majority of lumbar disc herniations do not require surgery.

 

Indications for Lumbar Micro discectomy

  • Cauda equina syndrome
  • Significant motor weakness
  • Intractable pain
  • Failed conservative treatment
    • Nonsteroidal anti-inflammatory drugs
    • Physical therapy for 8-12 weeks
    • Epidural Injection

 

marchtiger

 

 

Tiger Woods had a discectomy in 2014, and return to play 12 weeks later.

 

 

12wt

 

 

 

Phases of Rehab after Lumbar Discectomy:

 

returns

 

Phase 1: Post operative phase

  • Activity modification
  • Log roll transfers
  • Abdominal setting
  • Gluteal sets
  • Ankle pumps

 

Phase 2: Protected Mobilization phase

  • Abdominal and lumbar stabilization exercises in unloaded position
  • Modalities
  • Neural mobilization
  • Decrease fear of movement

 

Phase 3: Neutral Stabilization

  • Address muscle imbalances
  • Progress exercises from unloaded to loaded position
  • Initiate lumbar ROM

 

Phase 4: Dynamic stabilization

  • LE strengthening
  • Dynamic movements
  • Progress stabilization exercises

 

Phase 5: Sports specifics activities

  

 

So what are the outcomes for other elite athletes?

A recent systematic review by Dr. Reiman and his colleagues in BJSM found that not all athletes return to sport at the same level of play as before surgery.

 

In another systematic review on elite athletes there was differences in performance levels after surgery based on the sport played.

 

 

up1

Outcomes for Elite Athletes (CORR 2014)

  • A systematic review was performed on outcomes for elite athletes after micro discectomy.
  • 450 athletes were identified in various sports.
    • 36% were from the NFL
    • 16% from the NBA
    • 28% from NHL
    • 19% from the MLB,
    • Less than 1% of the 450 athletes included various Olympic athletes, martial artists, sailors and a ballerina.

 

yearsafter-md

 

Number of Years playing after Micro Discectomy

  • 8 years for MLB players
  • 1 years for NFL players
  • 6 years for NHL players

 

 

 md

 Games played after surgery

  • 232 games for MLB players
  • 36 games for NFL players
  • 129 games for NHL players

 

 

 mlb

 Difference between Non-op and Op for MLB players

  • Non-operative treatment of disc herniation returned to play at 3.6 months
  • Operative returned at 8.7 months.

 

 

 Performance

  • Only 3 articles reported on performance measures after lumbar disc herniation
  • Hockey players achieved 65%of performance measures from baseline after micro discectomy
  • Where as football players had improved performance >100% of their baseline
  • Earhart et al in 2012 found there was a sig. decrease in performance at 1 year after surgery in MLB.
  • No difference was found between operative and non operative cohorts in the NBA

 

 

Studies in this systematic review consisted mainly of low level III and IV evidence, however it could help elite athletes make decisions on weather or not to pursue surgery.

 

Check out this link to the BJSM podcast discussing Tiger Woods.

 

Also, if you’re studying for the OCS exam, check out our book with over 200 multiple-choice questions.

  • Only $9.99 on the Kindle App
    • Download onto phone or desktop
  • Paper back will drop in price very soon

 

All images were created in Power Point or Excel.

img_3600

Post written by Cody J. Mansfield

cody

 

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