Football Injuries Uncovered (Jack Eichel Edition): Cervical Herniation

Did Jack Eichel’s exit interview send chills down your herniated spines or what? If you’re a man over the age of 35, I know you felt it. As folklore goes, the older we get, the more frequently you hear a buddy has a ‘disc problem’. These can occur in, to the tune of my favorite rap song of all time, my neck, my back, ahh just like that. Currently, Jack Eichel is dealing with a cervical disc herniation. This is relevant because it is an injury that we have seen, can see, and will see in the game of football. Here is what you need to know.

Anatomy

Below is a picture of a cervical spine with a disc herniation. You can see how the disc, which is the gelatinous padding between vertebrae, pushes into the spinal cord and nerves.

Cervical anatomy, compared to lumbar (back) anatomy, allows better access to hit the spinal cord vs the spinal nerves. It is important to note that spinal cord injuries are scarier than spinal nerve injuries. Think more paralysis, compared to just sensory and motor loss with spinal nerve injuries.

Overview

In football, cervical spine injuries are estimated to occur in 10-15% of players (1). They can come in a variety of ways. Some may be so severe there is a ‘Kevin Everett’ situation, where there is trauma and fractures. However, they usually fall in a grey area when it is a cervical herniation. They are usually limiting early on but not catastrophic in nature. Symptoms could range from mild to severe. Mild would consist of pain and sensory deficits, whereas severe would likely include strength deficits. In most circumstances, 2/3 of people will recover with rehab and rest. However, if the person is still symptomatic after six weeks, they are more likely to need surgery to recover (2).

Plan of Care

If an athlete is getting treated for a cervical herniation, they are usually receiving physical therapy and other medical techniques. On the physical portion, this can include manual therapy, exercises, acupuncture, etc. Medication wise, the player would usually have a course of anti-inflammatories and possibly an epidural injection.

Surgical Options

Although there are some less invasive surgical options, such as the Percutaneous Endoscopic Cervical Discectomy (PECD), the gold standard would be an Anterior Discectomy and Cervical Fusion (ACDF) (3). One could view a PECD as a time-saving procedure that would eventually lead to an ACDF. Also, important to note, if a multi-level ACDF was needed in 3 or more vertebrae (for example), then it is almost certainly career-ending.

Below is a depiction of a PECD. An instrument from a surgeon takes out the leaked disc material.

Here we see an ACDF, which shows the damaged disc being removed, a bone graft placed between the affected vertebrae, and then metal plates to fuse the two together.

Outcomes

The bright news is 80% of professional athletes who undergo an ACDF return to play approximately 9 months post-surgery. The bad news is, the mean career length post-surgery was 3.2 years (4). There are many factors that can lead to the variability of the outcomes. For instance, players would be less likely to return if they have spinal cord trauma, significantly affected nerves, bony issues, and/or multiple levels injured in the spine. In regards to longevity, fusions can do a good job at their surgical site, but they make the joints immobile. Other joints above and below the fusion site will need to compensate and be forced into excessive movement. This can create adjacent deferment disease, which breaks down the joint and discs around the fusion. In these cases, additional herniations and bony issues can lead to additional fusion surgeries.

Football Example: Peyton Manning

Drawing a comparison of risks between football and hockey can be difficult. However, using a Quarterback’s risk rate could be considered comparable to a hockey player’s risk. Both can take vicious hits at times, but it’s not the repetitive trauma like an offensive or defensive lineman in football. With that said, let’s look at Peyton Manning. Peyton was reported to have initially had two less invasive surgeries, most likely the aforementioned PECD, before eventually needing an ACDF. After the ACDF, he returned for four seasons. The first three were miraculous, but the bottom dropped off in his fourth season as his nerve was shot. Although he was said to have had HGH shipments sent to his wife around this time, it nevertheless aligns with the 3-year career length post-surgery.

Jack’s Situation

So the captain has a cervical herniation. Unfortunately, we will never know the depth of his injury. As stated above, factors such as spinal cord involvement, bony changes, etc. would factor into if he really needs to operate ASAP. Emergencies aside, you need to wait and see how it goes for at least 6 weeks. Jack did his press conference a little over 9 weeks after his injury. Of course, there will be debates over the appropriate course of action, but yes a decision should be made fairly soon.

However, as the team captain, I have a personal issue with how he presented himself. Throwing the medical team and, quite honestly, the franchise under the boat was cringe. For someone who said he wasn’t totally clear on his neck’s situation (his words not mine), he sure sounded convincing; he wants out of Buffalo.

What Does This Mean for Jack?

This brings me to my conclusion. Jack may or may not need surgery. However, he is leveraging the fragility of his prognosis as a gateway to be traded. Unfortunately, all this did was damage his trade value and create chaos within the organization. Furthermore, if he really needs the surgery, and I hope not for his sake, he would be lucky to play out the remainder of his current contract.

To play devil’s advocate, there also could be more than meets the eye. Jack Eichel has one more year left on his deal before a no-trade clause provision kicks in. If the Sabres retained him until 2022, that would really limit his trade possibilities (ala the Taylor Hall situation of this year). Jack might be sniffing blood and knows the team is debating blowing up the roster and he is the big domino. In other words, he was beating them to the punch in a public fashion. But who knows?

What I do know is that for a 24-year-old superstar, I am sure the medical opinion is split at this juncture. Jack could have understood/respected that and interviewed in a more positive tone. However, now we are here with a tire fire.

Sources

1: Thomas BE, McCullen GM, Yuan HA. “Cervical spine injuries in football players”. J Am Acad Orthop Surg. 1999 Sep-Oct; 7(5):338-47. DOI: 10.5435/00124635-199909000-00006. PMID: 10504360.

2: Eubanks JD. “Cervical radiculopathy: nonoperative management of neck pain and radicular symptoms”. Am Fam Physician. 2010 Jan 01; 81(1): 33-40.

3: Ahn Y, Keum HJ, Shin SH. “Percutaneous Endoscopic Cervical Discectomy Versus Anterior Cervical Discectomy and Fusion: A Comparative Cohort Study with a Five-Year Follow-Up”. J Clin Med. 2020 Jan 29; 9(2): 371. DOI: 10.3390/jcm9020371. PMID: 32013206; PMCID: PMC7073710.

4: Watkins RG 4th, Chang D, Watkins RG 3rd. “Return to Play After Anterior Cervical Discectomy and Fusion in Professional Athletes”. Orthop J Sports Med. 2018; 6(6): 2325967118779672. Published 2018 Jun 18. DOI:10.1177/2325967118779672.