All the Cool Kids are Doing It

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Joe Montana, aka “Joe Cool”, passed for 31 touchdowns with only 13 interceptions in 1987-1988, the season following his back surgery. 

Many football fans did some soul searching recently when a spate of articles, including this terrifying report by New Yorker writer Malcolm Gladwell, detailed the long-term effects of repeated head trauma (it’s grim: an 18-year-old football player’s brain resembled someone’s who died from Alzheimer’s.)

I’m thinking it’s only a matter of time before the back surgery refugees of professional sports get similar treatment. But first – thanks to relentless media coverage of sports injuries – the “success stories” of our favorite athletes are going to drag some fans right down into the depths of chronic pain with them.

As a former newspaper reporter, I’m typically the last guy who’s willing to skewer the messenger. Nevertheless, consider these stories, culled from just the last four days of sports news:

1. Red Sox infielder Nick Green: The 31-year-old shortstop reportedly has a “slipped disc” in his back, complained of a ‘dead’ right leg and will undergo back surgery tomorrow (Nov. 9).

2. Atlanta Thrashers goaltender Kari Lehtonen: Will miss six to eight weeks after his second back surgery in three months. Surgeons reportedly removed edges of bone that were applying pressure to the nerve roots in two locations in the 25-year-old’s back. He had disk surgery on a different level in July.

3. Detroit Pistons forward Tayshaun Prince: He’s on rest for a ruptured disk, but the Pistons are saying back surgery “hasn’t been ruled out.”

4. Arizona State University defensive tackle Corey Adams: This highly-recruited freshman is said to be done for the year following back surgery.

Taken individually, these injury reports likely will have the relatively harmless, short-term effect of temporarily raising the blood pressure of sports fans in Boston, Atlanta, Detroit and Tempe. But for those with back pain – particularly those considering surgery – they have more lasting effects.

If you were suffering from sciatica, studying your treatment options, wouldn’t you naturally assume that one of Major League Baseball’s most storied franchises would protect their investment by getting their players the best, most cutting-edge treatment money can buy? Or that one of the NHL’s best up-and-coming goaltenders would be getting only the finest expert medical advice when it comes to repairing his back?

I remember Joe Montana’s back surgery, which took place in 1986. As a football fan, it was pretty hard to miss. Not surprisingly, Sports Illustrated reported that news of the procedure was displayed more prominently in Bay Area newspapers than a statewide election taking place at the same time.

In 1990, the year I had my first back surgery, Montana threw for nearly 4,000 yards. He injured his elbow, took some time off and came back to play for the Kansas City Chiefs for another couple of years.

I’d like to see some coverage of how these athletes are doing five, 10 and 20 years after the fact. Likely about as good as those who didn’t have surgery, according to this study. It showed those who undergo back surgery (risking  paralysis, infection, nerve damage and adverse anesthesia effects) do better only in the short term (unfortunately, benefits diminish over the long term).

So who’s to blame for thousands of often unnecessary back surgeries, costing patients pain and anguish and our overloaded medical system billions of dollars?

Not just our misguided belief in technology and tendency to emulate our heavily exposed sports heroes, that’s just part of the problem. Also consider:

1. The fact that U.S. back surgery rates have been measured at 40 percent higher than other countries. Rates are nearly uniformly higher in countries with higher per capita numbers of orthopedic surgeons and neurosurgeons. (Also see my previous post, “The Surgery Factory“, regarding the relationship between the number of MRI machines and back surgeries.)

2. The proliferation of the spinal implant industry, which spurred a 220 percent increase in U.S. lumbar spinal fusion surgery from 1990-2001 despite the fact that these operations delivered no proven increase in efficacy.

3. A fee-for-service U.S. health care model which rewards doctors and hospitals for prescribing procedures – including surgeries – often without requiring evidence that they actually work.

When it comes to athletes making millions of dollars, it’s not surprising that they’re willing to risk back surgery to recover quickly. Perhaps their handlers are convinced that surgery is the fastest way to get them back on the field or court.

My experience tells me that short-term perspective, and it’s impact on people in horrible pain and facing one of the toughest decisions of their lives, is a long-term mistake.

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