How Scary is Back Surgery?: what Dwight Howard & Michael Jackson have in common

| April 20, 2012 | 16 Comments

Dwight Howard, the Orlando Magic superstar, has been diagnosed with a herniated disk in his lower back and is set to undergo back surgery.

What kind of surgery will he have? What will it be like in the operating room? And what does he have in common with Michael Jackson?

Find out below.

Mr. Howard has already received an epidural injection, likely with steroid medications (not that kind of steroids!) to try to alleviate the pain and decrease the inflammation in the surrounding area.

How does a herniated disk cause pain?

Vertebral disks, in a sense, are the cushions between the bony vertebrae of your spine. They are made of cartilage-like material, and when one area of the disk is weakened, it can bulge outwards. This is called a herniation. If that “bulge” compresses or puts pressure on a nerve root it can cause tremendous pain and other neurologic symptoms. In the low back area, this can cause pain that shoots down the buttocks or leg (sciatica), weakness, numbness, or tingling sensations.

These symptoms can make walking difficult; never mind trying to be an elite athlete getting ready for a push into the playoffs.

The image below shows you what this looks like.

 

 

 

 

 

 

 

Treatment for herniated disks includes NSAIDS (non-steroidal anti-inflammtory drugs, eg. Ibuprofen), physical therapy, epidural steroid injections, and weeks of time. These epidural injections have apparently not been helpful to Mr. Howard. His condition has been deemed serious enough to require surgery. Though I have no inside knowledge of Mr. Howard’s personal medical history, from publicly available information it sounds like he is going to undergo a discectomy (or microdiscectomy).

Here’s what his experience will probably be like.

Mr. Howard will undergo general anesthesia for this procedure, which will likely take about an hour or so to complete. He will be asked to show up fasted, to help minimize the risk of gastric aspiration. After getting checked in to the facility, an intravenous catheter will be placed. This will be used to give him the medicine that induces general anesthesia, as well as IV fluids, pain medicine, anti-nausea medicine, antibiotics, etc.

Most likely, Mr. Howard will receive propofol to go off to sleep, now often known as the Michael Jackson drug. It should be noted that this drug is very safe when used by anesthesiologists in hospital settings. It is safely used thousands of times every day to induce general anesthesia across the country. Propofol is not indicated as a sleep aid, which is how Michael Jackson was using it. But it is indicated for general anesthesia, which is how Dwight Howard will likely receive it as he drifts off to sleep for his back surgery.

Once asleep, Mr. Howard will have a breathing tube placed past his vocal cords and into his windpipe. This is necessary to control his breathing and deliver anesthesia gases that will keep him under anesthesia for the duration of the procedure. What’s also unique about this type of surgery is that the patient has to be placed in the prone position (face down, laying on the belly).

Here’s what this looks like.

 

 

 

 

 

 

For surgeries in the prone position, the entire OR team takes special care to make sure all pressure points are padded. The head and neck is carefully placed in a neutral position. And special “pillows” are used to make sure the eyes and nose don’t have any pressure on them. The anesthesiologist takes care to regularly monitor the patient’s position throughout the surgery.

Mr. Howard’s size may also be a bit of a challenge. Being about 7 feet tall, the OR staff will have to make sure that their operating room table is big enough to safely handle Dwight’s large frame. Though his weight shouldn’t be an issue, his length could be.

It is a bit of irony that Dwight Howard’s nickname is Superman as he will be assuming the Superman pose for the duration of the surgery.

Once Dwight is in position and the back has been cleaned with sterile solution, the surgeon will access the spine through a small incision in the lower back. He/she will dissect down until the area is reached where the bulging disk is affecting the nerve root. The bulging part of the disc will then be removed, alleviating the pressure on the nerve tissue. Once the surgeon is satisfied the herniating disk material is no longer affecting the nerve root, he will stop and stitch back together the layers of tissue that were opened, including the skin.

When the surgery is complete, the patient will be placed in the supine position (laying on their back) and the anesthesia will be turned “off”. Once the patient is awake and breathing on their own, the breathing tube is removed and the patient is taken to the recovery room. Many surgeons will ask the patient to wiggle their toes as soon as they can follow directions to make sure that no neurologic complications occurred during the procedure.

Though it’s always scary to think of surgery in such a sensitive area like the spine, this is one of the more minor and quicker of the spine surgeries. Though the risks are not great, they include the possibility that the surgery is not completely effective. Other risks include bleeding, infection, risk of damage to spine or nerve roots, and the risks associated with anesthesia.

I’ll be keeping Mr. Howard in my prayers as he goes through his surgical procedure and the recovery that is to follow. Godspeed and quick healing!

If you have any questions about back surgery that weren’t answered, please post them in the comments below.

 

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Category: General Anesthesia

Comments (16)

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  1. Kevin says:

    What is the recovery timetable like for this sort of surgery? H

    • Dr Dave says:

      Hello Kevin,

      Thanks for your question.

      I’ll try to answer your question in several parts.

      Recovery from anesthesia will be similar to other general anesthetics. Usually, you will be monitored in a PACU (post anesthesia care unit) for about an hour to make sure the effects of anesthesia have worn off, your pain is controlled, nausea/vomiting is controlled, and that you have generally returned to your pre-operative state. From here, you will likely be taken to a “second stage” recovery area where you continue to be monitored to make sure you are tracking to be released to go home (this is often an out-patient procedure).

      Many factors can affect a person’s recovery from anesthesia, including age, length of anesthetic, and medical history, so I usually tell my patients to take it easy for about 24 hours: don’t operate any heavy machinery, sign any life-changing documents, etc. Common sense type stuff.

      As far as recovery for the surgery itself, your spine surgeon will be a better resource. This will likely be impacted by how significant your symptoms were beforehand, specifics about the disc herniation, and exact details about the course of surgery. It also depends on what you are referring to when you say “recovery”.

      A pinched nerve can cause pain, weakness, and numbness. Often most, if not all, of these symptoms see immediate improvement upon “waking” from anesthesia. Some symptoms can linger afterwards and take weeks to months to improve.

      As far as returning to work, folks with “white collar” type jobs can return to work in 1-2 weeks. This will likely be longer if your job requires physical activity (like Dwight Howard’s job).

      Again, these are all estimates. Your surgeon will give you a better idea of your specific circumstances.

      Hope this helps.

      Dr. Dave

      • Jose says:

        Hi Dr. Dave
        I have a herniated disc on my lower back, i already had epideral injections several times and just had surgery a(microdisectomy)9 months ago and it did’nt worked out it got herniated again and justed now found out i also have 3 disc on my midback. I don’t know what to do now my Doctor recomended me a fusion on my lower disc but i don’t want to. What will be your opinion?
        Thanks for your help.

        • Dr Dave says:

          Hello Jose,

          I’m so sorry to hear of your predicament. No doubt, you are going through so much with your complicated “back” history.

          Unfortunately, it would be inappropriate for me to give you any specific advice. First of all, I don’t have all of your medical information and can not act as your physician. Secondly, this is not my area of expertise. Advising you on whether further surgery is recommended, and what specific type (eg. fusion), is in the expertise of the spine surgeon.

          I can give you one suggestion. If you are not completely satisfied with the opinion of your current surgeon, you can consider getting a second opinion from another spine surgeon. Any good surgeon won’t get offended at this. They understand that a back fusion is a major surgery.

          At least you will then have the comfort of knowing and comparing the advice of two experts in that field. This may help you decide how to proceed from here.

          My thoughts and prayers go out to you and your family. Please let us know what you decide and how things turned out for you.

          Dr. Dave

      • Jan says:

        hi dr. dave,

        i had a microdiscectomy done last monday, 10/08/12 due to l4/l5 herniation. prior to surgery i complained to the surgeon that my left leg is not so good. i cant sgand too long nor walking fo 2 mins for i will feel pain right on my left butt down to my calf and foot. i accidentally injured my back last dec 20 of 2011. I have tried oral pills, pt, chiro and streroid sot but to no avail. so i decided to go for microdiscectomy.

        my question is, how come my right leg/foot was so numb and weak after surgery? prior to surgery i can walk, run and even play ball but with great pain after. now, i can barely walk due to numbness and weakness on the right leg/foot. my left side was okay and i dont feel any pain at all. just numbness and weakness.

        the NS told me that he stetched the nerve to be ablt to get off the disc..is this permanent? what should i do? i did mri but it seems fine, no reherniation or blood clot..

        thanks..

        • Dr Dave says:

          Jan,

          Thanks so much for checking in and sharing your experience.

          I’m sorry to hear that you’re having symptoms on the opposite side, now that your surgery is completed.

          It sounds like your neurosurgeon gave you a bit of an explanation of what may be going on. My hope is that any weakness, or numbness, or pain that you are feeling is/was temporary. Perhaps there was some swelling or inflammation there immediately after surgery that has subsided.

          I would follow up with the neurosurgeon, especially if your symptoms have not improved or gone away. They can give you a clear idea of what they found during surgery and exactly what they accomplished with the procedure.

          You are in my prayers. Please check back and let us know how your recovery is going.

          Sincerely,

          Dr. Dave

    • Jason Alleman says:

      Hi,

      I was very intrested in Mr. Howards condition and surgery today, because on ESPN this morning they reported he was not so HOT. Not so Super. I read another article where Mr. Howard says he is not himself. I don’t know why… Perhaps it’s his back?

      I have 7 herniated discs, 3 in my cervical and 4 in my lumbar. I had all the symptoms Mr. Howard has and worse.

      I wondering who preformed the surgery and the method of surgery used on Mr. Howard. I was scheduled for surgery and began searching for an alernative solution. I found Advance Bio Structural Correction, was treated, and canceled surgery. Since then I have been treated on a regular basis and not only have I avoided surgery, my condition is healing and the discs have receded. I have all the MRI’s to prove my conditions. Any one interested in this treatment please contact me via email…
      jaysdata@yahoo.com.

      • Dr Dave says:

        Jason,

        I have no experience with the alternative solution you mentioned, but I am glad it worked for you.

        Stay Healthy,

        Dr. Dave

  2. sean says:

    I have two herniated discs with tears. L4 and L5 I am in very good shape otherwise being a triathlete. I have had two cortizone shots and recently tried to do another triathlon but had to pull out of it during the run because of the discomfort and feeling that I didnt want to make it worse. My doctor mentioned fusion as a possibility but I have not heard good things regarding fusion. Are there other procedures out there that are effective? Look forward to hearing back.

    • DrJoe says:

      Hi Sean,

      I am sorry to hear about your back pain. I am sure that it is frustrating to be in great shape, but still have your activities limited by discomfort. And I can definitely sympathize because I strain my back several times each year. For the next 10 days, I feel miserable at work, walking, and even sleeping. Fortunately, though, my back pain resolves with conservative treatment. I usually use a heating pad and do stretches which provide some relief.

      You probably know that back pain is one of the most common reasons why patients visit a doctor. I have not had to schedule a visit yet to see a doctor about my back pain, but I am sure I will soon!

      Unfortunately, I cannot give you sound advice about other procedures that are more effective because I do not treat back pain as a part of my practice. The number one thing I would tell you, though, is to ask your doctor the same question you asked us. If he or she mentioned fusion, they may also have other suggestions or recommend that you see a back pain specialist.

      So sorry I cannot be more helpful. I do provide anesthesia for patients undergoing epidural steroid injections, fusions, laminectomies, and discectomies, but I cannot speak to the effectiveness of these therapies. This is the realm of pain management physicians, neurosurgeons, orthopedic surgeons, and physiatrists.

      Let me know what else you find out.

      Stay healthy,
      Dr. Joe

  3. Michael says:

    I had back surgery for disk problems, but I had artificial disk replacement, I recovered in about 2 weeks and I have not had any problems since. They go in through your stomach, remove the old disk and put in the new one. I hope this is what Dwight had he would have been back much quicker. That fusion surgery is old school to many problems in recovery and recovery is long, and you will never be right again.
    Knew to many people that had the fusion and said don’t go it, even doctors told me that.

  4. Chris says:

    Dr. Dave- I had bilateral disectomy surgery almost 5 months ago for a bulging disk. Unfortunately I only had a short time of any relief, and within 2 weeks all pain and numbness had returned to my gluts and legs. I am going to have the exact same surgery done again in a couple weeks in hopes that it will work this time. I noticed a message left for you previously about artificial disk replacement. Do you know much about this procedure. I know that it can be done in place of a fuse surgery, which would be next for me if this 2nd surgery does not work. I would appreciate hearing any thoughts/knowledge you have about the artificial disk replacement surgery, and when it is known to be an option for a patient. Thank you.

    Chris

    • Dr Dave says:

      Chris,

      Thanks for your question. I’m sorry to hear your first surgery only temporarily relieved your pain. I hope that your next procedure will bring you more permanent relief.

      As you mentioned, artificial disk replacement as well as a spinal fusion are options for those that continue to have problems with their vertebral disks. The topic, however, is a bit too complex to properly address in a comment.

      So Dr. Joe & I are working on a post that will address this topic. While we want to release it as soon as possible, we also want it to be high quality (Dr. Joe & I are both full-time practicing physicians).

      As always, while we will aim to explain these procedures and their indications, complications, etc. as clearly as possible, remember that your particular situation will be best assessed by your personal physician(s).

      Sincerely,

      Dr. Dave

  5. Michael Saulsberry says:

    Hey dr Dave. I was playing basketball with my sons
    3weeks ago and when I hoped the fence I landed very hard and I felt something. Prior n 2008 I had a microdiskectomy on L4 L5 which was successful however remembering the pain I went through I didn’t do physical therapy at all. I thnk. Made a boooobooo for sure. Here are my current MRI results. T12-L1 through L2-L3: The central canal and foramina are maintained. There is no evidence of disk herniation.
    L3-L4: There is a 2 mm lateralizing bulge with mild foraminal encroachment. The disc indents the thecal sac and the central canal is mildly stenotic.
    L4-L5: There is a 4 mm broad rightward protrusion with moderately severe right neural foraminal stenosis. The disc indents the thecal sac somewhat greater on the left with a 5 mm downward extrusion and suspect left L5 impingement.
    I have tried spinal decompression and it helped but not enough. I can’t walk,sit or stand without fire/electricity gong down my left leg from button. Is it because of me never doing PT that would have helped me threatened my core and thus the reason why I herniated it again? I hope to do a diskectomy again. I don’t not want fussion n fear of putting strain on other disk in the future. What other surgery would I qualify for besides fusion. Ps I’m a young 43

    • Dr Dave says:

      Michael,

      Thanks for your comment; and thanks for sharing with us your MRI results.

      I am so sorry to hear that you are again having issues with your back.

      Unfortunately, I can not give you any specific medical device. First off, that is not my field of expertise. A spine surgeon would be more qualified for the questions you are asking. I would be doing you a dis-service claiming otherwise. And secondly, in order to give out specific medical advice, a physician needs to do a complete history and physical exam before going to imaging studies.

      But it sounds to me that you should go see a spine surgeon for their medical opinion.

      In the meantime, I have just completed a post on Degenerative Disc Disease. You will find some useful information on back pain, spinal disc issues, and treatment options (including some short, cool videos showing surgical options).

      Hope this helps. Keep us updated on your progress.

      Dr. Dave

  6. sc341 says:

    I was going to leave a comment about my back condition but after reading through this website I won’t bother.

    P.S. Michael Jackson also had back issues, arthritis in his spine as per postmortem xrays taken. As far as i know no mri’s were done…..he could have had herniated discs, stenosis..etc…

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