Iron and Spine

Amanda Woerman, an accomplished triathlete and assistant professor of neurology at UCSF, had been having back pain on and off for six and a half years after suffering a herniated disc in graduate school.

“I would have periods where everything was fine, and then it would flare up and I wouldn’t be able to stand up straight and would have to do a lot of physical therapy,” she said.

But at the end of 2016 a flare up turned into persistent pain. Even so, she continued a regular training schedule of swimming, biking and running. Her physicians first tried medications and injections, but the pain continued and her neurological symptoms worsened. It started to become difficult to perform activities of daily living like commuting to work or sitting for long periods at the lab bench.

“Then all of a sudden, things started to progress really rapidly,” she said. “In the course of a week, I went from being able to walk a couple blocks to not even being able to cross the room. The pain escalated exponentially.”

In July 2017, she was referred to the UCSF Spine Center to undergo a minimally invasive discectomy to remove part of the herniated disc.

“Amanda had developed loss of feeling in her foot, weakness, tingling, and foot drop,” said neurosurgeon Aaron Clark, MD, PhD. “The rapid worsening of these neurological symptoms and the focused injury made her a good candidate for surgery.”

Despite her ongoing pain, Woerman had registered for a full IRONMAN competition to take place in November 2017 in Arizona and she was worried that surgery would mean forgoing a goal she had worked towards for years. But Dr. Clark was optimistic that a minimally invasive procedure would mean a short time to full recovery.

“I had been in such a dark place, trying to figure out how I could still do it and watching that dream slip away,” she said. “So hearing Dr. Clark say he thought I would still be able to do it just completely changed my outlook. It felt like I went from living under a cloud with rain to having sun shining on me.”

The minimally invasive L4-5 discectomy was done with specialized instruments through a 16-mm tube – about the width of a dime.

“When we do this procedure minimally invasively, we don’t strip the paraspinal muscles from the spine, so recovery is a lot faster,” said Dr. Clark. “Because it preserves the muscle, minimally invasive surgery can be an especially great option for athletes and patients who prioritize highly active lifestyles.”

Woerman started cycling and swimming seven weeks after surgery and running again within 12 weeks. At 18 weeks she realized one of her biggest dreams and crossed the finish line to become an IRONMAN.

“I really resisted the idea of surgery for a long time,” said Woerman. “And waking up in the hospital pain free for the first time in six years, my only thought was ‘Why did I wait so long?’ I’ve become a big advocate for minimally invasive surgery.”