After an operation on his back at a Cleveland hospital yesterday, Cal Ripken stands a reasonable chance of returning to the field next spring, experts say. But the outlook is far from certain.
"All he needs is for the nerves to be relieved of their compression and he stands a good chance of returning to the same level of function he had before," said Dr. Alex Curcin, a spinal surgeon at Sinai Hospital.
Still, Ripken will face stiffer demands than the average patient.
"He's a guy who has demonstrated he can play through physical adversity," said Dr. Ira Fedder, a spinal surgeon at St. Joseph's Medical Center. "But it's going to be very tough for him. Because he's an elite athlete, he needs to play at an elite level."
Orioles officials would not say exactly what was wrong with Ripken's back, but they have said broadly that he suffers from a condition in his lower back known as spinal stenosis. This is a compression of the nerves that branch out from the spinal cord to the legs.
The problem can cause searing pain in the back as well as numbness and pain in one leg. It usually occurs in older patients, but affects younger people, too. Athletes are at risk because of the strain placed on their spine. The condition is also an occupational hazard of truck drivers, airline pilots and others who sit for long periods.
An elite surgeon
Though the surgery is considered routine, and there are local surgeons equal to the task, Ripken sought out Dr. Henry H. "Hank" Bohlman, a 62-year-old spinal surgeon whose hands are on the same elite level as Ripken's glove. Bohlman has operated on a number of professional athletes, Arab royalty and others from around the world.
Ripken's case is considered far easier than the complex cases he usually handles.
"The procedure he did on Ripken is something he could do in his sleep," said Dr. Brian Victoroff, a partner of Bohlman's at Case Western Reserve University Hospitals. Bohlman, considered among the top few spinal surgeons in the country, has made his mark in research and teaching. He trained at the University of Maryland Medical School and Johns Hopkins Hospital.
Bohlman listens to classical music while operating, and colleagues say the atmosphere is as relaxed as a cocktail party. Physicians want to train under him, partly because he's so cool in a crisis.
Two years ago, Victoroff walked into an operating room to observe, and he was surprised to hear a familiar voice from the gurney.
"Hi, Brian, how are you?"
It was Bohlman undergoing the same procedure that Ripken had, except he was under local anesthesia, something most patients couldn't handle. For the rest of the operation, Victoroff said, they chatted as if they were at lunch.
A common cause of spinal stenosis is a herniated disk, a condition in which the shock-absorbing cushion between two vertebrae slips out of position and presses painfully against a nerve. Another cause is arthritis, a degeneration of the bones that surround the spinal cord and nerve branches.
Problems go together
Fedder of St. Joseph's Medical Center said the two problems often go together: Over time, the disk wears down, and this leads to a deterioration of bone. Arthritic patients often develop bone spurs that press against nerves.
"You have disk material pushing on the nerves and arthritic joints pushing on the nerves," said Fedder. "Its a continuum. Almost everyone who has had a disk herniation eventually develops degenerative changes in the joints."
Baltimore surgeons said the operation typically goes like this:
The patient is given general anesthesia and placed in a kneeling position over a cushioned frame that keeps his back elevated but parallel to the table. The surgeon makes a 4- to 6-inch incision, then removes a portion of the bony covering that protects the spinal canal.
With the canal exposed, surgeons trim any tissue that is irritating the nerves. This can include bone spurs and all or part of a bulging disk. After a simple disk operation, some patients can leave the hospital a day later. Patients who undergo more complicated surgery might stay three days.
After surgery, patients can be in considerable pain. During their hospital stay, many are hooked to a pump that allows them, within limits, to dose themselves with pain medication. Later, they take painkilling pills at home.
Recovery time varies.
Sinai's Curcin said he recommends a week of rest followed by "four to six weeks of progressively increasing activities" along with physical therapy that is designed to increase strength and flexibility. Then, if all goes well, the average patient can return to work.
Said Fedder: "People who have spinal stenosis usually have a very good chance of having improvement in how their legs feel and function, probably in the 80 to 90 percent range. That doesn't mean function as well as before or that they will be completely normal."
Fielding a challenge
For Ripken, swinging a bat might be easier than playing third base. At the plate, players can set themselves and control their swing, Fedder said. "In the field, you have to move and bend and twist wherever the ball goes."
Dr. John P. Kostuik, chief of spinal surgery and chairman of the orthopedics department at Johns Hopkins Hospital, said he has not seen Ripken's X-rays, but from what he understands, "if Mr. Ripken wants to continue to play baseball, there is no reason he can't next year, providing the operation is successful." Kostuik said that Ripken was seen at Hopkins a few years ago with a back problem, before turning to Case Western this time.
"I don't know why Mr. Ripken decided to go there," said Kostuik, who is considered among the top spinal surgeons in the country. "I think it's probably a good thing to get out of a small town like Baltimore. It's not a bad idea sometimes when you're famous to leave town."