Professional Athletes, Spine Surgery, and Patient Choice

What an NHL player’s medical choice has to do with athletes and patients everywhere.

Spine surgery is serious business, and no surgeon on the planet will tell you differently. A physician’s decision to recommend it and a patient’s choice to undergo it are steeped in a considerable amount of education, trust, and faith. I was recently asked to comment for an article on NHL star and newest member of the Las Vegas Golden Knights Jack Eichel’s choice to undergo artificial disc replacement surgery to repair his herniated cervical disc, outside his former team’s (Buffalo Sabres) recommendation, which preferred a procedure called anterior cervical discectomy and fusion (ACDF).

I want to back up a bit and provide some background on the spinal condition known as a herniated disc, as well as the two procedures in question for Eichel’s case. A herniated disc occurs when the rubbery cushion (the disc) between two spinal vertebrae cracks and allows its interior gel-like material to press out and beyond its tougher exterior. Sometimes, this phenomenon causes no symptoms at all, and patients may never know they’ve experienced a disc herniation. In other cases, the herniation can irritate the nerves surrounding the spine, resulting in neck or back pain and numbness, and weakness in the arms and legs, depending on where the herniated disc is located. Most disc herniations improve with time, and some don’t. In Eichel’s case, the disk herniation in his neck ended his most recent NHL season early and attempts to resolve the issue with conservative treatments and rehabilitation proved unsuccessful. Everyone involved agreed that the next right step was surgery. The question was, which type?

The medical experts for Eichel’s former team preferred he go with the ACDF procedure. This surgery type involves the removal of the damaged disc and fusion of the bone above and below it. This procedure helps to alleviate pressure on the affected nerves while stabilizing the vertebrae in the spine. Eichel’s team had solid reasons for their recommendation. The ACDF procedure has a long track record and has proven successful in helping other high-contact professional athletes return to play post-surgery. Whether NFL, MLB, or other NFL athletes, some studies indicate that the return to play for these athletes post-operation is upwards of 80 percent. However, Eichel consulted with his own doctors, and through their counsel, he decided he wanted to pursue a different surgical type – called artificial disc replacement.

Though ACDF may have been around for longer, artificial disc replacement surgery is becoming a popular and routine procedure for many patients. Disk replacement surgery involves the removal of the damaged disk, like ACDF, but instead of fusing the vertebral bones, a new, artificial disk is placed where the damaged disk used to be. This procedure still achieves the goal of removing the offending disc and pressure on the nerves, while also allowing for the motion of the neck and spine to return to normal. In contrast, ACDF surgery can make a normal range of motion more challenging due to the fusion of bones. However, since an artificial disc replacement has never been performed on a professional hockey player, it likely factored into the decision by Eichel’s former team to make the recommendation for ACDF. Yet, the recovery after artificial disc replacement surgery can allow patients to be up and walking soon after the procedure and with little downtime – six weeks or so for soft tissues to adequately heal up.

Ultimately, Eichel’s choice had him seeking a new team, one that would allow him the autonomy to choose which procedure he believed best for him and his future NHL career. That decision could have incredible and positive ripple effects for the future of sports medicine – undoubtedly related to artificial disc replacement surgery. There is no reason to believe this procedure won’t prove to be a success for Eichel. Even if the procedure hasn’t been performed on a professional hockey player, there is plenty of data on the efficacy of disc replacement surgery. There is nothing experimental about this procedure, and just because it hasn’t been done on a professional athlete doesn’t mean it shouldn’t be done.

Eichel’s decision to do what he believed was right for his body and future goals is a fine example to patients everywhere. As I have written many times, one of the determining factors of success for ANY surgical spine procedure is a patient who trusts the surgeon performing it, believes it is the right procedure for them and has faith in a positive and successful outcome.

Neel Anand MD