Kerr’s advice to avoid surgery eye-opener for doctors, patients
“Stay away from back surgery.” When Steve Kerr offered that frank, take-it-from-me advice to others suffering from back problems, the Golden State Warriors coach turned himself into Exhibit A for the potential complications from surgery and sent a chill through waiting rooms in surgeons’ offices throughout the country.
But is what happened to the coach common?
It’s “certainly not in the majority of cases,” said Dr. Lionel Metz, an assistant professor of orthopedic surgery at UC San Francisco.
But it’s not uncommon, experts say, for surgeons to nick a membrane surrounding the spinal cord during spinal surgery because of the incredibly delicate location of the procedure. The fluid that leaks from that membrane, known as the dura, can lead to excruciating pain.
Sidelined indefinitely
Debilitated by chronic headaches from a spinal fluid leak since he underwent back surgery two years ago, Kerr announced Sunday he will be sidelined indefinitely as the Warriors continue their quest for an NBA championship.
A second surgery followed two months later to repair Kerr’s leak, but by October 2015, he was still in pain.
“I can tell you if you’re listening out there, if you have a back problem, stay away from surgery,’’ Kerr told reporters. “I can say that from the bottom of my heart. Rehab, rehab, rehab. Don’t let anyone get in there.”
Yet many surgeons and patients involved with these procedures disagree with Kerr.
“I can understand where he is coming from — he personally had a very bad experience,” said Dr. Kee Kim, chief of spinal neurosurgery at UC Davis and co-director of the school’s Spine Center. “But most patients do well after surgery.”
Kim doesn’t know the details of Kerr’s case, but said it sounds like the coach may have a “persistent spinal leak,’’ something Kim has studied and written about over the years. He says dural tears are more common than people realize.
Kerr’s original surgery, on July 28, 2015, to repair a ruptured disk ran into a complication at some point during or after the surgery when the membrane was accidentally nicked.
The coach missed almost half of the Warriors’ record-setting 2015-16 regular season and the pain is still so bad that he stepped aside after Game 2 of Warriors’ first-round playoff series against the Portland Trail Blazers.
He continues to consult with his doctors, hoping for some improvement. Kerr has tried just about everything over the last year and a half for relief, including medicine, yoga, meditation, exercise and even marijuana.
Metz said a dural tear can occur inadvertently during surgery when a surgeon using a bone removal tool accidentally nicks the dura. In fact, he said, it’s happened to most surgeons. But they also can happen after surgery, because areas of the removed bone may still have sharp edges.
“The dura is very, very thin — think of the dura like a balloon holding spinal fluid and nerve roots,” Metz said. “We are basically working around that balloon to remove the bulging part of the disk.”
If the dura is nicked during surgery, the surgeon would usually notice the clear fluid leaking, said Metz, and repair the tear with a suture.
However, an “occult dural tear” only becomes apparent after the surgery, when a patient experiences symptoms including headaches and dizziness, caused by the change in pressure around the spinal cord and brain.
Doctors recommend a number of solutions: a trial period of bed rest, or an attempt to “bolster” the wound so it increases pressure outside the skin, and hopefully helps the wound to seal over.
Another option, said Metz, is a drain inserted through the skin that diverts the cerebrospinal fluid, decreasing the pressure inside the dura. If that doesn’t work, he said, another surgery would be the next option.
Will Kerr follow his own advice and avoid back surgery at all cost?
Fear of surgery
Sunny Martinez, 41, who has had two back surgeries after being diagnosed with a disk degenerative disease, thinks the coach spoke too soon about avoiding back surgery.
“I still have pain, and I’m fearful of another back surgery in my future,” said the Concord resident and media saleswoman. But, she added, “I wouldn’t think twice about going under the knife again.
“When you can’t walk, sit, or sleep — when you are literally crawling off your couch — you will try anything,” said Martinez.
The same goes for 67year-old musician Glenn Letsch of Walnut Creek. Years ago, a laminectomy stopped the pain shooting down his leg. When that procedure wore off, he had two of his vertebrae fused with screws.
Over time, despite that procedure, the pain returned and became unbearable. He found a new surgeon in San Ramon who realized the screws should have been removed. That was in 2006 — and Letsch has been pain-free ever since.
But Sherri Segelken said she agrees with Kerr. She had her first back surgery in 2006, and said it caused more damage and more pain since. “I tried everything to get relief,” she said, including more surgeries.
Now, Segelken said, “when I hear a friend or family member say they are having problems with their back, I always say: Back surgery should be the last resort.”