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The Peyton Manning Surgery: What is a Cervical Fusion Surgery?

On September 9th, 2011, Denver Bronco's quarterback Peyton Manning underwent his 4th Neck Surgery, a Cervical Spine Fusion. The technical medical term is "Anterior Cervical Decompression and Fusion" (ACDF), which means "Neck Surgery performed from the front of the Neck to remove Nerve Compression and then fuse Vertebrae together".

By all reports, Peyton Manning suffered from a combination of two Disc problems in the Neck: 1. A Herniation which was putting pressure on a Nerve traveling to his right Triceps Muscle  2. Degeneration of a Disc which means loss of elasticity and function.

Now that we have learned about the Neck conditions which can cause Nerve compression, lets take a look at Peyton Manning's surgery, a Neck Fusion. This Surgery is from the front of the Spine. Why? Because everything between the Skin and the Spine in the front of the Neck is soft! Also, the Spinal Nerves and Spinal Cord are located just behind the Disc. So, doing Surgery from the front means we do not have to go around the Spinal Cord to get to the Disc. On the back of the Spine our muscles are powerful and tough. If you have to remove their attachment points from the Vertebrae, they may never reattach completely, which can cause chronic muscle pain and weakness. For a football player who has to constantly scan the field, this approach to the Spine could be career ending.

Here is how the Surgery is done:

1. A small incision is made in the front of the Neck

2. All the structures between the Skin and the Spine are essentially pushed out of the way.

3. Once the Disc comes into view, it is removed in its entirety all the way down to the Spinal Cord.

4. The Nerve channels located behind and off to the side of the Disc are freed up.

5. A Bone Graft is placed into the Space which was created when the Disc was removed. This Bone

    Graft can be Synthetic Bone, Cadaver Bone, or the patient's own Bone. Peyton Manning reportedly

    had some his own Bone harvested from the Hip Bone to make the Bone Graft. This is the

    Gold Standard", i.e. best chance to achieve a Fusion.

6. After the Bone Graft is in the ideal position, a small Titanium Plate is placed over it. This connects

   the Vertebrae above and below the Bone Graft to help it grow to the Vertebrae. Small Titanium Screws secure the Fusion Plate to the Vertebrae.

The final true and solid Bone Fusion usually takes 3-6 months to complete. The Titanium Plates and Screws give the Spine stability until the Bones are fully fused. During that time, a football player cannot be involved in contact sports since the Spine is still weak. Even though you would think that a Titanium Plate could absorb a lot of force and act as a good protector for contact sports, these plates are not meant for this type of force and are prone to breaking. The final bone fusion is much stronger than the Titanium Plates. What are the typical chances that a Bone Fusion actually takes place? Typically over 90%.

So, why did Peyton Manning have a Fusion rather than either something less invasive or an Artificial Disc Replacement? First off, he did have at least one less invasive Surgery done. It was an endoscopic Surgery (small fiberoptic tube) which was done through a small hole from the back of the Spine. However, these Surgeries make it difficult to see and get access to the whole compressed Nerve. It was not successful in relieving the Nerve Compression in Peyton Manning's neck. That leave the subject of an Artificial Disc Replacement. The Artificial Discs still allow the space between the Vertebrae to move, which would be a good thing for an athlete. However, Artificial Disc Replacements were not designed for contact sports. It is generally not known how much force they can take. These Devices could potentially get dislodged with force, which could conceivably push them into the Spinal Cord and cause paralysis. This was a risk not worth taking for a football player who is exposed to some hard hits.

So what does the future hold for Peyton Manning's neck? The good news is that the fusion in his neck is solid which has earned him the endorsement of his Spine Surgeon, Dr. Robert Watkins to continue in his career. However, statistics are against Peyton from a standpoint of the long-term outcome of his Surgery. Neck Fusions have the disadvantage of causing more force and pressure on the Discs above and below the Fusion. Over time these Discs wear out faster than expected just due to aging. Statistically, this means a 3% per Year risk of needing another Surgery at one of these Discs. Chances are that he will last through his NFL career, unless he suffers a significant injury to one of the vulnerable Discs above and below the Fusion.