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Manning Cervical Radiculopathy

 Among recent recurring stories in sports is speculation regarding the successful return of Indianapolis Colts quarterback Peyton Manning.  On September 8th of this year, Manning underwent a third surgery to alleviate pressure on a nerve root in his neck.

 The cervical spine consists of seven bones called vertebrae located below the skull.  Discs made of cartilage separate each of the vertebrae to avoid the friction and wear of bone rubbing on bone.  This entire system is held together by a series of ligaments.

 The cervical spine is designed to protect the spinal cord and the nerve roots that emerge from the spinal cord to conduct motor and sensory impulses to and from the limbs and vital organs.  Damage to these fragile nerves can result in paralysis or death.

 Typical injuries to the cervical spine include:

• Fracture of the vertebral bones 
• Tearing of the ligaments that attach the bony vertebrae 
• Rupture of the intervertebral discs from their central location

 In football and other violent collision sports, it is not uncommon to see worn and ruptured discs on imaging studies like MRI and CT scans.  Unfortunately, these findings are sometimes seen in young  healthy athletes.

 The cervical nerve roots responsible for triggering the muscles of the arm are also the ones most commonly injured. Without adequate neural control, throwing is a difficult task, especially for an NFL quarterback. 

 Surgical intervention includes removing pieces of the offending discs.  If the surgery or surgeries require removing a large volume of disc, bone chips are inserted between the vertebrae to prevent dislocation.

 While fusing the spine creates a firm repair, it also limits the range of motion of the neck.  It is this loss of motion, along with arm weakness, that will make Manning’s return a formidable challenge.

 Peyton Manning’s recovery will require all the discipline and effort he has acquired over the years.

 Anthony G. Alessi, MD, is Stroke Center Medical Director at The William W. Backus Hospital and in private practice at NeuroDiagnostics, LLC, in Norwich. E-mail him at aalessi@wwbh.org, or listen to his podcasts, comment on his blog or buy his book at www.backushospital.org.