How Tiger Woods Won the Back Surgery Lottery

Original Article from the New York Times

Tiger Woods practiced on Tuesday ahead of the P.G.A. Championship, which begins on Thursday at Bethpage on Long Island. Credit - Peter Casey/USA Today Sports, via Reuters

Tiger Woods practiced on Tuesday ahead of the P.G.A. Championship, which begins on Thursday at Bethpage on Long Island. Credit – Peter Casey/USA Today Sports, via Reuters


Few would have predicted that Tiger Woods would be playing in the P.G.A. Championship this week. He had three failed back surgeries, starting in 2014. He had taken opioids. His astonishing career seemed over.

Then he had one more operation, a spinal fusion, the most complex of all, in 2017. And last month he won the Masters, playing the way he used to.

An outcome like his from fusion surgery is so rare it is “like winning the lottery,” Dr. Sohail K. Mirza, a spine surgeon at Dartmouth, said.

To read more, please click here to go to the New York Times article.

CLINICAL PRACTICE. Herniated Lumbar Inter-vertebral Disk.

Deyo RA, Mirza SK
N Engl J Med. 2016 May 5;374(18):1763-72. doi: 10.1056/NEJMcp1512658.
PMID: 27144851 DOI: 10.1056/NEJMcp1512658 in News

This Journal feature begins with a case vignette highlighting a common clinical problem. Evidence supporting various strategies is then presented, followed by a review of formal guidelines, when they exist. The article ends with the authors’ clinical recommendations.

A 41-year-old man reports the sudden onset of low back and left leg pain. The symptoms began while he was doing yard work and pulling out large bushes. Since the onset of the pain 2 days ago, it has worsened, although he took a single dose of ibuprofen when the pain began. The patient has no clinically significant medical history, and the physical examination is normal other than severe pain in the left leg with a straight-leg-raising maneuver to 40 degrees. He says, “I’m sure I slipped a disk,” and he requests magnetic resonance imaging (MRI) of the low back. What testing and treatment would you recommend?

Bone Morphogenetic Protein Use and Cancer Risk Among Patients Undergoing Lumbar Arthrodesis: A Case-Cohort Study Using the SEER-Medicare Database

Beachler DC, Yanik EL2, Martin BI3, Pfeiffer RM2, Mirza SK3, Deyo RA4, Engels EA2.
J Bone Joint Surg Am. 2016 Jul 6;98(13):1064-72. doi: 10.2106/JBJS.15.01106.
PMCID:PMC4928039 [Available on 2017-07-06] DOI:10.2106/JBJS.15.01106 in News

Cumulative incidence of cancer according to BMP use in patients who underwent lumbar spinal arthrodesis (fusion) in this case-cohort study. The asterisk indicates that the number of patients at risk of cancer at the start of each year of follow-up was estimated as 20 times the size of the 5% sub-cohort, given that 100% of the cancer cases were included in this study.




Recombinant bone morphogenetic proteins (BMP’s) are growth factors utilized in lumbar arthrodeses. Limited data from randomized trials suggest that BMP may increase cancer risk. We sought to evaluate cancer risk and mortality following the use of BMP in lumbar arthrodesis.


Within the linked Surveillance, Epidemiology, and End Results (SEER) Program-Medicare cohort, we conducted a case-cohort study of 7,278 individuals who were ≥65 years of age and had undergone a lumbar arthrodesis from 2004 to 2011. Of these patients, 3,627 were individuals in a 5% random sub-cohort of Medicare enrollees in SEER areas including 191 who developed cancer, and there were 3,651 individuals outside the sub-cohort who developed cancer. Weighted Cox proportional-hazards regression was used to estimate hazard ratios (HR’s) and 95% confidence intervals (95% CI’s) for cancer on the basis of exposure to BMP.


In the SEER-Medicare sub-cohort, 30.7% of individuals who underwent a lumbar arthrodesis received BMP. BMP was not associated with overall cancer risk in univariate analyses (HR, 0.92 [95% CI, 0.82 to 1.02]) or after adjustment for demographic characteristics, comorbidities, hospital size, history of cancer, and calendar year (adjusted HR, 0.94 [95% CI, 0.84 to 1.05]). Individual cancer types were also not significantly elevated (p > 0.05 for all) in BMP users compared with nonusers. In addition, BMP use was not associated with a new cancer in people who had cancer prior to undergoing lumbar arthrodesis (adjusted HR, 1.04 [95% CI, 0.71 to 1.52]) or with mortality after a cancer diagnosis (adjusted HR, 1.05 [95% CI, 0.93 to 1.19]).


In a large population of elderly U.S. adults undergoing lumbar arthrodesis, BMP use was not associated with cancer risk or mortality.
LEVEL OF EVIDENCE: Therapeutic Level III.