Super Bowl Quarterback Peyton Manning
Peyton Manning, the Denver Broncos quarterback, will cap off a miraculous recovery from a serious neck injury with his appearance in the Super Bowl this weekend. Mr. Manning has undergone numerous surgeries and procedures on his cervical spine. The details of his medical treatment and rehabilitation are the topic of speculation on many sports talk shows. We do know that he underwent an anterior fusion of his sixth and seventh cervical vertebrae. An incision is made in the front of the neck and the two bones are fused together using screws and a titanium plate. The fusion removes compressive forces off the nerve root that exits between the vertebrae and eliminates any movement between these two spinal segments.
Compression on the seventh cervical nerve root creates all kinds of problems for someone who throws a football for a living. This nerve root carries the signals that fire the triceps muscle (back of the arm) and muscles that help grip the ball. Trauma to the seventh cervical nerve root can cause loss of sensation in the fourth and fifth fingers of the hand. Loss of neural control not only has an effect on muscle strength, but also on power production. You need to be able to create muscle contractions quickly to throw a pass with any velocity. If the signal that is sent down the seventh cervical nerve root is impeded by compression or inflammation, the pass will be slow.
There are risks associated with playing professional football with a fused cervical spine. When you fuse the sixth and seventh vertebrae together, you lose about 10% of the range of motion in your neck and you also lose some of the shock absorption capacity in your spine. The compressive forces and range of motion lost at the fused C6-7 segments are transferred to the vertebrae above and below the fusion. In the general population, thirty percent of the patients who undergo a cervical fusion require a second fusion in 10 years. I was unable to find a statistic on pro football players, but I am certain this percentage has to be much higher.
Cervical fusions are not uncommon in professional football, and 70% of the players who have a fusion are able to return to competition. Mr. Manning plays at the high skill position of quarterback and his passing numbers this year have been amazing. Win or lose this weekend, Peyton Manning, surgical medicine, and physical rehabilitation deserve applause.
Michael S. O’Hara, P.T., OCS, CSCS