Earlier this year, New York Giants running back David Wilson underwent spinal fusion surgery to repair a herniated disc in his neck. The procedure aimed to fix lingering neurological symptoms that did not improve with rest, which the Giants considered a "long shot" to begin with, according to the New York Post's Paul Schwartz:
The Giants and Wilson were hoping to avoid surgery, on the chance that rest and treatment alone would reduce the herniated disk. That was always considered a long-shot scenario, and now a surgical procedure has been deemed necessary.
The operation—and the Hospital for Special Surgery's Dr. Frank Cammisa, who led the surgical team according to Schwartz—rejuvenated Wilson's career. In fact, the running back himself announced his medical clearance for "everything" earlier this month.
Everything proceeded according to plan until Tuesday, when Schwartz tweeted that a "burner" forced the young back from practice. Newsday's Tom Rock added that Wilson underwent tests at the Hospital for Special Surgery later that night.
It goes without saying that the entire NFL community hopes for nothing but the best.
To better understand what Wilson is facing, let's take a look at the spine, burners—or "stingers"—and a few of the possible scenarios going forward.
Please be aware that the following represents educated speculation and nothing more. As always, precise NFL player medical data, images and testing are not available to the general public.
The Cervical Spine, the Spinal Canal and Stingers
Each of the bumps in the neck and back represents one vertebra—the bones that encase and protect the spinal cord as it runs from the brain to the lower back. The shapes of the vertebrae are complex, but within each is a small, bony ring inside which the spinal cord sits. The rings as a whole make up the "spinal column."
Nerves must leave the spinal cord and exit the spinal canal to travel to the rest of the body and control movement, sensation and the other functions of the body.
In some cases, the spinal canal can narrow at one or more vertebral levels. Causes of a narrow canal—or spinal stenosis—include but are not limited to:
- A herniated intervertebral disc: The cushioning cartilage disc that lies between adjacent vertebrae moves out of place.
- Vertebral bone spurs: Bony growths that result from chronic, degenerative changes in the spine.
- Congenital stenosis: The vertebrae may grow and develop in such a way that the spinal column is narrower at baseline.
Spinal stenosis can lead to a higher risk of stingers—or an injury thought to arise by stretching of the nerves as they exit the spinal canal. Stingers can occur when any blow to the head, neck or body causes the neck to sharply bend to one side.
Symptoms include pain, weakness or numbness in a specific area of the neck, shoulder and arm, and the precise location of symptoms depends on exactly which nerve level or levels the trauma over-stretches.
For example, pinching of the C5 nerve root—the nerve that exits the spinal cord between the fourth and fifth vertebrae from the top of the spine—may lead to biceps and deltoid weakness, numbness in the front of the arm and forearm or any or all of the above.
Best-Case Scenario: Brief Stinger of Minimal Consequence
In and of themselves, stingers are fairly common throughout football. In fact, Dr. Andrew Hecht—co-chief of spine surgery and director of the Spine Center at Mount Sinai Medical Center in New York City—recently told The Austin Chronicle's Alex Dunlap that approximately half of NFL players will suffer a stinger at some point in their careers.
Perhaps Wilson's most recent injury represents nothing more than a one-off incident unrelated to his recent cervical spine fusion. If his symptoms arose in a different location than previously, a different spinal level may be to blame.
That said, given Wilson's history of cervical spinal stenosis that Schwartz mentioned in the above column—as well as the persistent symptoms that necessitated surgery—the concern that the running back's most recent injury represents something more than a bit of bad luck is a very real one.
Worst-Case Scenario: A Harbinger of Further Serious Issues
Cervical spinal stenosis not only increases an athlete's risk of burners, it also brings about the possibility of suffering an episode of cervical cord neurapraxia (CCN). Dr. Hecht mentions this frightening condition in his interview with Dunlap.
In CCN, an athlete temporarily loses part or all function—both motor and sensory—in up to all four limbs. Usually, the numbness and paralysis resolve with time.
Free-agent tight end Jermichael Finley went down with a terrifying episode of CCN last season. It is important to emphasize that in Finley's case, reports of pre-existing stenosis did not, and still do not, exist. As such, directly comparing Wilson to Finley is likely inappropriate.
Nevertheless, if tests on Wilson show persistent stenosis—at another spinal level, for instance—his return to the field becomes a much more complicated issue.
Dr. Neel Anand, clinical professor of surgery and director of spine trauma at Cedars-Sinai Spine Center in Los Angeles, weighed in on the risks of playing with cervical stenosis.
"If surgery was successfully performed to correct the cervical spinal stenosis, there are no further risks. Peyton Manning is a perfect example of this." Dr. Anand said. "However, if Wilson continues to experience stingers, this may indicate an additional level of stenosis that needs to be assessed."
What about the chances of a catastrophic injury, such as the heartbreaking case of former Rutgers University player Eric LeGrand?
Research by Dr. Joseph Torg and colleagues in the late 1990s suggests cervical stenosis predisposes to CCN, and those who suffer one episode are at higher risk of another in the future. However, Torg also concluded that an increased risk of catastrophic neurologic injury in those who suffer an episode of CCN does not exist.
That said, Dunlap notes that Dr. Hecht still takes caution.
While Dr. Hecht says that it goes against what the research and literature universally support, it just seems logical to expect that with each instance of neuropraxia, there may be an increased risk of a more serious spinal cord injury at some point.
Dr. Anand commented about an increased risk of spinal-cord damage when it comes to stenosis. Keep in mind that stenosis and CCN are related but different entities.
"There is an increased risk of catastrophic neurological injury if the player's cervical spinal stenosis is severe, undiagnosed and (if he) suffers a major injury to the spinal cord," Dr. Anand explained.
In the end, the MRIs, CT scans, neurological tests and other evaluations will help clarify Wilson's ultimate disposition, but the entire football community surely looked upon today's news with a bit of disbelief.
Hopefully, today's events represent nothing more than a minor bump on his road to recovery, though for now, fans are left merely hoping for the best.
Dr. Dave Siebert is a second-year resident physician at the University of Washington who plans to pursue fellowship training in Primary Care (non-operative) Sports Medicine. Quotes were obtained firsthand unless otherwise noted.
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