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 microdiskectomy.
*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!