Why Steve Kerr Should Not Have Chosen Surgery

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As the Golden State Warriors play their first game in the next round of the playoffs, they will again be without their head coach Steve Kerr.

Kerr’s life has seemingly changed forever. It is brutally difficult to see the debilitating effects of a botched surgical lower back procedure as is the case for the five-time basketball champion.

It’s interesting how humanity works. Under the right circumstances, we find a soft spot for anyone we may not be too fond of.

I am Golden State Warriors hater. Mostly because they have many of the top NBA players and the New York Knicks don’t. Plus, their signing of Kevin Durant, arguably a top three player in professional basketball, made me more jelly (the word that popped into my brain as I write this. Urban language for jealous).

But looking at another man suffering from a debilitating illness is heartbreaking. Especially when it was medically induced.

Kerr works out daily and does yoga to help control the symptoms.

“I’m not going to go into details on the symptoms. It’s just discomfort and pain, and it’s no fun. And I can tell you if you’re listening out there, if you have a back problem, stay away from surgery. I can say that from the bottom of my heart. Rehab, rehab, rehab. Don’t let anybody get in there,” he said.

Yep! Rehab!

Some facts about lower back pain

Despite the fact that major medical organizations like the American College of Physicians and the American Pain Society (ACP/APS) recommend against excess imagings for back pain, the use of Magnetic Resonance Imagings (MRI) and Computed Tomography (CT) scan for lower back pain continues to skyrocket.

That’s important because the more you image, the more you treat. In other words, the more ones seeks to find a problem, the likelihood that problem would be “fixed” surgically – at least this is the case with lower back pain. (Lurie et al. 2003)

Why excess imaging leads to excess surgery in lower back pain?

Many reasons. One of them is that you demand it. (Tangum et al. 1998)

Most patients with lower back pain need to know the root of the problem and the fact is that our imaging technology is too good. MRI’s and CT scans will find stuff. The question is, will finding structural abnormalities lead to treatment that helps take the pain away?

Not often.

One of the most common diagnoses’ for lower back pain is herniated discs.

If I were to pull ten people off the street without lower back pain and order an MRI on them, eight would have a herniated disc. Herniated discs are extremely common and unlikely the cause of lower back pain. (Jensen et al. 1994) Crazy!

Other factors contributing to excess imaging and treatment of lower back pain is fear of getting sewed by physicians.  Doctors are reluctant to get into lawsuits as our world is highly litigious. Doing nothing can be grounds for a trip to the court. Unfortunately, so is doing something causing an adverse event.
One randomized trial showed a trend toward more surgery among patients receiving early spinal MRI, but no better clinical outcomes (Jarvik et al. 2003).

Back to Steve Kerr and his Unfortunate situation

Although I am not a fan of the Warriors, I am empathic for Steve Kerr.

I feel for this guy not only because he was a basketball star as a player, and now as a coach, but because he accomplished much despite many life challenges.

Briefly, Steve Kerr was born in Beirut, Lebanon, during a time of unrest in the country.
After many threats to his family, his father, an academician and the president of the American University of Beirut, was assassinated outside of his office when Steve was 18 years old.

This New York Times article is a good read on Steve Kerr’s background if you have time.

His fathers assassination was traumatizing for Steve Kerr, as you can imagine. I am a fan of anyone who overcomes odds.

About two years ago, Kerr was suffering from lower back pain related to a ruptured disc likely from the stress of having been an athlete, he thinks.

He decided to undergo back surgery and the surgeon inadvertenly nicked the dura matter of the spine.

Spine Anatomy 101

To bring more context to the story, let’s easily discuss the anatomy of the spinal cord.

The brain and the spinal cord are connected and covered the by an outer layer called the meninges. (You may have heard of meningitis, an inflammatory infection of the meninges).

The meninges consist of three layers:

  • The layer closest to the spine and brain is called the pia mater.
  • The second layer called the arachnoid.
  • And the outermost part, the third layer is called the dura mater.

Cerebral spinal fluid (CFS) is a color-less fluid found only in the brain and spinal cord and its critical purpose is to protect the brain.

CFS leakage is what’s causing Steve Kerr to step down, hopefully temporarily, as coach of the hot playing Warriors.

How does Cerebral Spinal Fluid Leakage happen?

There are many causes of CFS leakage:

When a surgeon nicks the dura mater, CFS leakage occurs. The only way of fixing the problem is with another surgical procedure, which often works, except for Kerr it did not.

Symptoms from CFS leakage are headaches, nausea and stiff neck. Intensity can vary.

What could Steve Kerr have done differently to prevent this problem?

It’s too easy to look back in hindsight and figure out what could have been different, right?

But I’ll say this:

Steve Kerr himself said if he could do it over again he’d go to rehab first. Despite his ruptured discs, that might have worked, even if only temporarily.

Quality articles have been written on exercises to alleviate lower back pain.

This reporter/blogger had extreme lower back pain causing him suicidal thoughts. He did benefit from surgery to some degree then with chiropractic care and acupuncture for maintenance. Indeed, this study indicates that such non-invasive methods help.

Other non-pharmacological approaches such as Mindfulness based stress reduction, acupuncture, yoga and tai chi has also shown to help bring relief to those suffering from lower back pain. (Source: Annals of Internal Medicine Journal)

I take botanicals that seem to be safe for pain and lowering inflammations including, corydalis, curcumin, boswellia. My go to is Inflammatone for modifying inflammation –  about two to four capsules to times a day, depending on the severity of the pain.

Finally, I do not want to send the wrong message on this post to avoid surgery at all costs  – or that surgeons are unreliable doctors. Surgeons are fallible like you and me.

I find it interesting how in baseball a batter who hits .300 average is considered a great hitter. Only once did anyone in the history of baseball finish a season with an average of over .400. I hate to say it as a Yankee fan, but that baseball player was from the Boston Red Sox ☹, Ted Williams.

For those who don’t know baseball, let me tell you what this means:

Batting .300 average means for every ten times a batter goes to hit the ball; they hit the ball well enough to get on base three times. So they hit three for ten, average, and that’s an excellent hitter.

Doctors are expected to hit one-thousand every single time. That is not humanly possible. That is why I am also empathic for the surgeon who attempted to fix Kerr’s back and unintentionally severed his dura matter.

That said, it’s no secret that there are too many unnecessary surgeries performed in the United States. Non-invasive approaches should always be the first line of therapy for lower back pain.

 

References:

Lurie JD, Birkmeyer NJ, Weinstein JN. Rates of advanced spinal imaging and spine surgery. Spine. 2003;28:616–20.

McPhillips-Tangum CA, Cherkin DC, Rhodes LA, Markham C. Reasons for repeated medical visits among patients with chronic back pain. J Gen Intern Med. 1998;13:289–295.

Jensen MC, Brant-Zawadzki MN, Obuchowski N, Modic MT, Malkasian D, Ross JS. Magnetic resonance imaging of the lumbar spine in people without back pain. N Engl J Med. 1994;331:69–73.

Jarvik JG, Hollingworth W, Martin B, et al. Rapid magnetic resonance imaging vs radiographs for patients with low back pain; a randomized controlled trial. JAMA. 2003;289:2810–8.

Resource:

SPINAL CSF LEAK FOUNDATION

 

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by Dr. Geo

9 comments… add one
  • Hi Geo,

    Your blog comments this morning came on heals of the Mike and Mike shoe report of Steve Kerr’s story. I was devastated to hear about his ordeal and thought how glad I am that my son David chose physical therapy over surgery for his back problem. He’s now black my, swimming and playing racquetball.

    As for .400 hitters

    Reply
  • Dr. Geo:

    Great article and I agree with you. I am a 69 year old Family Physician with severe DDD in my back. I am now on WC because of a slip and fall at work but because of my aggressive rehab program I will return to work soon. Years ago I had a foot drop so my physicians did an MRI scan and told me that I needed immediate surgery. I said “no thanks” and the foot drop gradually disappears. I walk 6-10 miles daily and often swim for an hour. I told my surgeon that he wanted to see me beat Bolt in the 100 m dash–come at me with a scalpel!

    Reply
  • Jo ,

    Dr. Geo,
    Thanks for providing that explanation for what has happened to my favourite coach of my favourite team. Sorry you dont like them – but they are great.
    I was hoping there was going to be a glimmer of hope that he can be fixed but that did not come. I just hope and pray that even the symptoms will go and that he feels better soon.

    Reply
    • I like Steve Kerr. And I hope he gets better soon. I am just jealous the Knicks cannot acquire great players like KD. That’s all. 🙂

      Reply
  • Rick ,

    Great blog on Steve Kerr. I have a similar problem that herniates 3-4 times per year. I will do anything I can to avoid surgery and now, after reading your blog, may never opt for surgery.

    Reply
  • Gary de Sesa Ph.D. ,

    Thank you for enlightening those who do not realize that medical errors are the 3rd leading cause of death in the US. Pretty scary. I will pass along this excellent article to friends of mine who are currently dealing with back pain and may be contemplating surgery.

    Reply

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