JOHNSON'S BACK SURGERY CONCERNS MARINERS : SOME WONDER IF OPERATION WILL WORK PROPERLY.

Byline: Bill Knight Seattle Post-Intelligencer 

There's nothing common about Randy Johnson's pitching. He won the 1995 American League Cy Young Award. He was the most dominant pitcher in the game, terrifying rival hitters.

Just as unusual is his 6-foot-10 stature, which enhances his skills.

Johnson has something in common, though, with about 80 percent of Americans: a sore back. Only the common cold is responsible for more trips to the family doctor.

Because of the pain that has prevented Johnson from helping the Mariners in their stretch run at the American League West championship, he is scheduled to undergo lower-back surgery Thursday in Los Angeles.

Will the operation succeed, as Johnson's doctors predict?

Will he be able to resume his role on the Kingdome pitching mound next season, intimidating opposing batters?

Medical experts generally agree with the forecast of Johnson's physicians, who think he has a good chance of recovery.

They respect the skills of Dr. Robert Watkins, the prominent Los Angeles surgeon who will perform the operation on Johnson and who recommended surgery about two weeks ago.

But some experts are concerned because of uncertainties involved in lower-back treatment and the controversy triggered by a variety of studies and reports done within the medical profession.

Example: One study said of the 200,000 herniated-disc surgeries performed each year, about 40 percent - or 80,000 operations - are not necessary.

Example: Follow-up studies of patients 10 years after back problems were diagnosed show that those who were treated without surgery fared about the same as those who had surgery.

Dr. David F. Apple, an Atlanta surgeon and spokesman for the American Academy of Orthopedic Surgeons, points out that back surgery can be an inexact science. He advises getting second opinions before going under the knife.

``Unfortunately, nobody has the right answer,'' Apple said. ``What is right for one patient is not right for another. Statistically, about 30 percent of patients are better, 30 percent are about the same (after surgery) and 30 percent are worse.''

Dr. Richard Deyo, a professor at the University of Washington School of Medicine, helped write back-treatment guidelines for use by primary-care physicians.

Those guidelines suggest that about 80 or 90 percent of patients with herniated discs improve after four to six weeks of conservative treatment, without surgery.

For the remaining 10 or 20 percent, surgery becomes a reasonable option, Deyo said. Johnson appears to fall in that category.

``If you select patients carefully, meaning that they meet the criteria for surgery of this type, the success rate ought to be pretty good, that probably 80 percent should improve substantially from surgery,'' Deyo said.

The surgery on Johnson will focus on the fifth lumbar disc in the small of his back. The discs act as shock absorbers between the vertebrae in the spine. When part of a disc protrudes from its normal position and compresses a nerve, it causes pain.

The term ``herniation'' is used to describe how the disc is squeezed out of position.

What the surgeon expects to accomplish Thursday is to remove a part of the disc and relieve the pressure on the nerve.

Johnson is expected to take about eight weeks to rehabilitate. If all goes well, he should be mended well before the start of spring training in February.

Too often, Apple said, lower-back surgery is done too quickly, without the same thorough examination and consideration of all factors that went into the Johnson case.

``Sometimes a patient comes in after an automobile crash, gets an MRI (magnetic resonance imaging) test that shows an abnormality and they end up getting operated on. That's when it doesn't work,'' Apple said. ``The patient gets scar tissue and has a problem the rest of his life.''

The criteria indicating the possible need for disc surgery, as outlined by the American Academy of Orthopedic Surgeons, include:

A pain in the leg, indicating a nerve is being pinched. This is more telling than back pain.

Signs in a physical examination that the nerve root is being pinched.

Imaging tests that correspond with other symptoms.

Failure to respond to non-surgical treatment after four to six weeks. The majority of patients will improve in that time.

``I guess the problem is if you look at all comers - all patients and surgeons - they aren't all that carefully selected, and as soon as you deviate from those criteria and say, `Well, I have a hunch this will help,' the results probably aren't as good,'' Deyo said.

Deyo cites another possible scenario for failure.

``I think a lot of surgery gets done because people kind of throw up their hands and say, `Well, we've tried everything else and it hasn't worked.' I argue that's a bad reason to operate on somebody.

``You operate for a very specific anatomical and physiological abnormality and if people don't have that abnormality, surgery is not likely to help that much,'' Deyo said.

Apple, who also serves as the Atlanta Hawks' team physician, said athletes often feel obligated to undergo surgery in order to return to the playing field.

``I know some of the pressures put on everyone when you're dealing with a professional athlete,'' he said. ``Of course, the team wants him back. The player wants to get back playing and he might do something quicker than you might if you didn't have the pressure of winning or losing on your back.''

Although follow-up studies of back patients showed they were about the same after 10 years, surgery or no surgery, in the first few years those who underwent surgery had an advantage, according to Deyo.

Johnson first complained of pain in late April and has gone through an extensive range of treatment. He tried to return as a relief pitcher in August, but the discomfort did not subside.

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Photo: The Mariners wonder if back surgery will allow Randy Johnson to return to the dominant form he had when he won the Cy Young award in 1995.

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