Commentary by Baron Lonner, MD

Jeanette Lee’s victory over Kelly Isaac was as much a test of wills as it was a game of pool.  It took almost two hours to win the match at the Tornado Women’s 9-Ball Open. Bleary-eyed and feeling like a used piece of pool cue chalk after completing her third game of the day, Lee let it all out on social media. “OK, I’ve been around too long to be finishing a match at almost 2 a.m.!” Lee posted on her Facebook page.

A Career Without Curves!
It’s safe to say she has seen a lot late nights in a career that has spanned more than 20 years. Her 9-12 finish at the event in San Antonio notwithstanding, Lee has racked up one of the most illustrious careers in billiards history with more than 30 national and international titles to her credit. Her proudest moment came in 2001, when she won a gold medal for the United States at the World Games.

What’s just as impressive is that Lee is one of the few to transcend the sport. The Black Widow has been the (glamorous) face of a sport many people used to only associate with smoky halls and hustlers. Hey, you know you’ve gone from pool player to the pop culture lexicon if you’ve been listed as one of Esquire’s “Ten Women We Love” and have appeared on “The Late Show with David Letterman.”

But for every public appearance, there have been dozens of hard-fought battles with the newcomer du jour determined to take out the former No. 1 player in the world. Through it all, however, her biggest nemesis has been her back.

Scoliosis Spokesperson
According to Lee, she has undergone 11 surgeries from arthritis, degenerative disc disease, herniated discs, deteriorated discs in her neck and back and bursitis in both shoulders and both hips.

She believes a lot of it can be traced back to her childhood in Brooklyn and the day 12-year-old Lee went to the beach with her mom. The sight of the curve of her daughter’s spine sent her right to a doctor.          

“The doctor took one look and immediately knew it was scoliosis,” Lee once told USA Today. “My spine was shaped like an S with both curves over 55 degrees so it was very severe. And they told me what the options were, and that I’d need surgery, but I don’t think it really made sense to me what was happening.”       

Some 3 million Americans of all ages have this sideways curvature of the spine, although it occurs most often during the growth spurt just before puberty. Scoliosis can be caused by conditions such as cerebral palsy and muscular dystrophy, but the cause of most cases is unknown (idiopathic).      

Children who have mild scoliosis are monitored closely, and in many cases, no treatment is necessary. Some children will need to wear a brace to stop the curve from worsening. In more severe cases, however, surgery is required.        

Lee underwent surgical treatment of her scoliosis, which included rods to help realign and stabilize the curve. Afterward, however, she didn’t wear her brace. She said she was self-conscious and shy and would take it off and put it in her locker at school until it was time to go home. Appearances aside, braces can be hot and uncomfortable, and limit spinal mobility. But as Lee says, “I wish I had been told more clearly how important wearing that brace was because I really did not wear it like I should have.”

Eventually, she developed a herniated disc in her neck and pain in her shoulder. In a sport that requires flexibility around a table, not to mention laser-focused concentration, it got to the point that she had to stop playing pool and start on her litany of surgeries.

Exercise Key to Lee’s Routine
She also told Billiards Digest that she began doing a regiment of low-impact exercises to stretch and strengthen her back muscles. She mentioned doing crunches and taking brisk walks, but her favorite is swimming. “Swimming supports your back while strengthening it,” Lee said. “It develops your chest and back muscles and helps regulate your breathing, which can be tough when your back is really hurting.”

National Spokesperson for the Scoliosis Association
She has been able to share her journey with countless children over the past two decades that she’s served as a national spokesperson for the Scoliosis Association. Connecting with kids has been a cathartic experience for Lee. "I feel really lucky because my experience was difficult, but I overcame it," Lee told USA Today. “I became the national spokesperson because I want to help other girls avoid a lot of pain, embarrassment and loneliness. The reason I had really long hair was to hide my scars, because I felt horribly insecure and ugly. Now I show people my scar. The more I have talked about this, the better I felt.”

Commentary

Baron Lonner, MD
Professor of Orthopedic Surgery
Mount Sinai School of Medicine, New York

I read Jeanette Lee’s story with great interest and respect for what she has endured physically, psychologically, and socially due to her condition, idiopathic scoliosis, and the treatment she has undergone. Her story illustrates the courage many patients with scoliosis exhibit in living with the disease.

Jeanette underwent surgery, I assume, 20 or more years ago when bracing may have been used after surgery during the healing process. Today, casting or bracing after surgery is rarely required for idiopathic scoliosis. In my practice, patients are able to return to sports by 3 months or even sooner in some cases.

My group has studied return to sport in adolescent idiopathic scoliosis and has found that the vast majority of patients return to their same sport(s), at the same level of play, and similar number of hours per week following contemporary scoliosis surgery. The patient’s ultimate outcome and activity level is impacted by the number of levels of the spine fused, how well alignment is restored, the individual’s fitness level and probably by genetic factors, which may have an affect on the development of late-onset degenerative disc disease. Jeanette has benefited from her exercise regimen, including low-impact, core strengthening and aerobic activities such as swimming which in my experience is a crucial factor in preventing back pain following surgery.

Of course, Jeannette’s chosen work, professional pool player, results in her assuming awkward positions and performing repetitive motions, which eventually may lead to the development of musculoskeletal overuse problems such as a herniated disc in the neck which she has experienced. We have found that scoliosis surgeons, themselves are at risk for overuse conditions such as rotator cuff, lateral epicondylitis (tennis elbow) and neck problems due to the long hours, and repetitive maneuvers associated with this type of surgery.¹

Innovations in scoliosis surgery over the years have resulted in shorter fusions and preservation of flexibility, growth and function. Ten years ago, we were performing video-assisted anterior thoracoscopic spinal fusion, which saved 3 levels of fusion compared to standard posterior approaches.² We are now beginning the era of non-fusion anterior procedures or tethering utilizing the same skills we developed for the anterior fusions in hundreds of patients. These techniques hold the promise of preserving function and minimizing the risk of adjacent segment degeneration or wear and tear. Further study of tethering is required but early results are promising.

Jeanette Lee, being a high profile individual who has been seen by millions of viewers has had to come to terms with her body image in the face of her scoliosis and her subsequent surgery for it. She was embarrassed by her brace and by her scar and hid it with her long hair. These are common themes that we have come to understand in patients with scoliosis. My team and I have delved into these concerns that patients have that may also affect their social interactions and self-esteem and have developed two different outcome questionnaires to better understand how the individual with scoliosis is impacted by the condition--these are the Body Image Disturbance Questionnaire for Scoliosis and the Truncal Anterior Asymmetry Scoliosis Questionnaire.³ What I have been impressed by is the resilience and courage of the majority of scoliosis patients living full, productive, and rewarding lives.