When medicine makes its own miracles

We live in incredible times and Tiger Woods' recent return to golfing excellence is just one example of a reality that should make us take a step back and marvel at the pace of human achievement.

Woods has a back that's left him crippled, and three spinal fusion surgeries didn't help.

I know how this goes. Back in the '60s, my brother had the same surgery. He was in the hospital for weeks, and then in a bed at home for about a year in his junior year in high school. He attended school using only a two-way speaker, carried from class to class down at the high school. He was unable to leave that bed.

The surgery, as it turned out, didn't work. He missed out on the socialization that's important in high school, his hunchback made him an easy target, and when he finally was free to go off to college, he couldn't really handle the freedom.

So he worked in a factory until, like most factories in Massachusetts in the '70s, it closed.

A string of health problems left him homebound until he died a few years ago.

So stories of medical achievement in 2019, like the New York Times' report today on Woods' breakthrough, cause both moments of celebration and bittersweet reflection.

Spinal fusion surgery removes a disc in the spine, along with the nerve-cushioning jelly, and fuse the remaining spine together. In theory, the pain disappears, but the patient has less flexibility in matters of the back.

From the sound of things, Woods' surgery shouldn't have worked. He shouldn't have beeen able to return as a champion golfer. But he did.

Dr. Richard Deyo, an emeritus professor of medicine at Oregon Health and Science University, and his colleagues conducted a study in Oregon and found that about half of fusion patients who had the procedure on their lumbar, or lower, spine were using opioids before their operations. After their surgery, only 9 percent stopped using the drugs. And 13 percent who had not used opioids became long-term users after the surgery.

It’s hard to know what constitutes success, Dr. Deyo said. For example, one study, one of whose co-authors was Richard Guyer of the Texas Back Institute, who was widely reported to be Woods’s surgeon, reported a “clinical success rate” of 57 percent after two years. It defined clinical success as at least a 25 percent improvement in overall functioning, with no device failure, no major complications and no neurological deterioration.

Only knee and hip replacement is a more popular surgery than spinal fusion, the Times says. And it hints that Woods' pain problems will likely return, but not before he gets a few more big paydays.

But these are what baby steps in medicine look like, and this is why the world of medicine provides something that few other avenues of life on terra firma provide: hope for the future.

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