Wednesday, May 25, 2011
Appropriate medical questions for Manning
By Paul Kuharsky
It’s difficult to learn of Peyton Manning's neck surgery and not be left with a load of questions.
I’ve got my own, but consider those of medical people unfamiliar with the case but more familiar with necks and surgeries to be far more relevant.
Colts quarterback Peyton Manning had surgery on his neck Monday, his second in the past 15 months.
Here’s what ESPN’s resident medical expert, physical therapist Stephania Bell told me she’d like to know:
Was the first procedure, last March, a formainotomy, where they widen the tunnel where the nerve root exits from the spine to alleviate compression? “At the time, the procedure was referred to as something to alleviate symptoms associated with a pinched nerve.”
Was the procedure Monday a microendoscopic discectomy, where they might remove a piece of disc tissue that's causing trouble? “Microendoscopic discectomies are considered ‘minimally invasive’ procedures and players can -- and do -- come back and do quite well, but naturally anything that is done relative to the spine is considered serious by virtue of the location. The advantage to this newer microendoscopic approach is that it avoids trauma to the muscles surrounding the neck, which is critical in both recovery and long-term stability of the area. Jim Irsay has tweeted of Manning: ‘He had a bulging disk. The doctors removed a part of it.’ That sounds consistent with this procedure.”
Was the second procedure at the same spinal level as the previous one? Even if the procedures were different, was this done at the same vertebral level as the prior procedure? “It might reflect differently on his overall condition if he had two levels that were problematic vs. one level that ultimately required a second procedure.”
What were the symptoms that led to this? “Do you remember how several times during the season people wondered about Manning's arm strength -- there were some inaccurate throws, occasionally underthrown balls, atypical for him. I wondered about it. If his shoulder was being affected because of issues in his neck, it could have led to some of that. (Reason: muscles in the shoulder get their nerve supply, and consequently their power, from the nerve roots in the neck. If those nerve roots are being compromised in any way, it can impair function, even in a subtle fashion, in the upper extremity. It's always hard to say definitively from a distance -- and it's virtually impossible for me to comment on it without knowing WHICH levels were involved or what symptoms he was experiencing.”
Those questions help us understand what could be going on. As for the answers? Well, we know how Manning and the Colts are about internal (pun intended) details and few in the NFL offer up such specifics. We’re not going to be getting any soon. I wouldn’t even expect a detailed paragraph in Manning’s autobiography, if he writes one after his career is over.
Two surgeries within 15 months could hint at degenerative/wear-and-tear issues in the spine. Even non-athletes who are not subject to weekly batterings suffer such things as they get older. Manning is 35 and a lot of people are anxious to start the conversation about the start of a downturn in his career.
It’s jumping the gun, in my opinion, especially with what we don’t know.
We need look no further than John Elway to find a high-quality quarterback who had his biggest successes after 35.
I have trouble seeing the beginning of the end knowing how much better the Colts will be around Manning in the personnel department this season after a solid draft and time for a ton of injured guys to get healthy.