Colts Quarterback Peyton Manning Undergoes Spine Surgery
On opening night of the NFL, one of the most decorated quarterbacks in the history of the league is recovering from cervical spinal surgery. His third surgery in about 1.5 years, Peyton Manning underwent a single level fusion in the cervical (neck) area of his spine. The biggest questions on everyone’s minds are will he return and will this end his career?
The spine is made up of vertebral bodies that make the vertebral column. In the neck (cervical) region, there are 7 bones, in the back (thorax) region, there are 12 bones, and in the lower back (lumbar) region there are 5 bones.
Each bone interacts in a complex manner with the bone above and beneath it. Furthermore, the spinal canal is home to the spinal cord. Throughout the length of the spinal cord, nerves (known as nerve roots) come off the cord to provide function to that level of the body.
In addition, between the bones are cushioned disks, known as vertebral discs, which act as shock absorbers along the length of the vertebral column. Finally a series of ligaments and muscles attach to the bones to provide stability and flexibility to the spine.
In the neck, the first two vertebral bodies are known as the atlas and axis bones. The next 5 bones are known as C3, C4, C5, C6, and C7. The spinal canal is largest in this area.
Repetitive motions in the neck, trauma to the neck, or genetic predispositions can lead one to develop arthritis in the joint in and around the vertebral column and spinal cord or a herniation of a disc. With arthritis, bone spurs can develop. The bone spurs can push on the spinal cord itself or on the nerve roots. This can cause nerve or neurologic type symptoms.
A disc can also bulge and lead to the same symptoms.
Individuals can have symptoms of pain with motion of the neck, pain with motion of the body that the nerve root supplies, numbness, tingling, loss of strength and motion.
WHEN TO SEEK MEDICAL CARE
If you suspect that you have a cervical spine issue, you should seek medical attention within a few days of the onset of symptoms, especially if the symptoms are not improving. A physical exam and x-rays are usually performed, however often times an MRI or CT scan may be needed to evaluate the spine.
Treatment varies depending on the severity of the pain and the nature of the underlying cause of pain, i.e. arthritis or a herniated disc. Initial treatment may include a neck brace, anti-inflammatories, physical therapy, neck injections with steroids and numbing medications. If this fails, surgery may be required to remove the disc that is pushing on the cord, remove the bone spurs that are pushing on the cord or fuse the joint between two vertebral bodies. The fusion can be done from the front or back of the neck.
Manning underwent an anterior cervical fusion of one joint. He likely had a discectomy (where the intervertebral disc is removed) with the fusion. A bone graft is usually placed where the disc used to be. This helps to maintain the height of the vertebral column. Plates and screws are normally placed in the bones to stabilize the area of fusion. Once the fusion occurs, this hardware is no longer functional.
Most patients with cervical spine pain improve with conservative care. If this fails, surgery can improve symptoms and functional losses.
RETURN TO ACTIVITIES
Peyton Manning has undergone a cervical spine fusion. The bone usually takes 12 weeks to fuse. At times, this can heal faster, but should not be expected. After fusion, a prolonged course of therapy will be needed to regain some of the loss of function, mobility, and strength from the underlying disease and the surgery. Given this, I would be very surprised if Peyton returned this season, even if the Colts make it deep into the play-offs.
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