Category: Minimally Invasive Surgery, Procedures | Author: Stefano Sinicropi
With the Super Bowl coming up this Sunday, there has been much discussion about Peyton Manning’s neck surgeries and rehabilitation. But what exactly did Peyton go through and how did he get back to be the best QB in the league?
From the ages of 15 and 35, Peyton NEVER missed a game with an injury. His storied career included making every start for 14 seasons with the Colts, winning four most valuable player awards, and the 2006 Super Bowl. But then his discs and joints in his neck hit the critical point where he started having serious pain and issues with throwing. As the build-up of arthritis and disc bulging progressed, the nerve became pinched (this is known as Spinal Stenosis or Nerve Compression). He eventually underwent his first surgery in February of 2010.
Posterior Cervical Foraminotomy
The procedure he underwent is called a posterior cervical foraminotomy. This surgery is done through the back of the neck and can relieve the pressure of a compressed nerve. It can in many cases completely relieve the pain and weakness caused from a pinched nerve. But one of the drawbacks may be that it does not address the disc as a whole as a fusion or disc replacement surgery would.
Unfortunately the pain came back with a vengeance and Peyton underwent two more decompression surgeries to try to better relieve pressure from the recurrent disc herniations. Following the surgeries the pain improved dramatically but he continued to have significant weakness in his triceps.
Instability & Arm Weakness
The story became more frustrating for Peyton, as the degeneration of the spine at that level had become more severe and x-rays began to show signs of instability (abnormal motion of the cervical bones). Instability can make compression on nerves much more serious in certain positions and hamper any type of rehabilitation. At this point the prognosis was certainly worsening as far as his ability to get back on the football field.
As his desperation increased, Peyton flew to Europe four times, trying various alternative therapies trying to improve nerve function including the use of stem cells. There continued to be no improvement.
Not only was his arm weak, but he also started losing proprioception or the awareness of his arm in space. “It’s hard to explain but I kind of lost awareness of my arm in space,” stated Peyton. One can imagine that at this point he must have begun to fear that his career was in serious jeopardy.
Finally, after failed conservative treatments and a long workup, Manning underwent a fourth surgery, which was a single-level anterior fusion. Dr. Watkins performed the operation on September 9th, 2011. In this procedure, the surgeon removes the herniated disc and replaces it with bone (a bone graft) and places a metal plate, which is screwed in above and below the removed disc. This takes the pressure off the affected nerve, stabilizes the spinal column and reduces pain and numbness as a result. When Manning woke up, he couldn’t penetrate the dartboard with a dart. “I could barely get the thing to stick,” he says.
Manning then carefully followed his post-operative instructions, and began to recover the strength in his triceps. A long, slow rehab process began with some frustrations. However, this time with a stable neck following the fusion, things began coming along nicely and his throwing motion and strength improved dramatically with time. After another MVP season, Peyton manning will strut out to the field to lead his Broncos in the Super Bowl.
The Anterior Cervical Decompression and Fusion is one of the most common and studied procedures in our field. It is the gold standard procedure for spinal stenosis and instability in the neck. The ability of Peyton to get back on the football field and return to greatness, is a testament to how well patients can recover following this procedure, and get back to almost any activity.