It Is Official - Peyton Had 2nd Neck Surgery. A 1 Level "Neck Fusion"

[ViriLudant]

Aha. Just read the Colts statement and this jumped out at me:

“This procedure is performed regularly throughout the country on persons from all walks of life, including professional football players. Two former Colts players had this same procedure last winter and have fully resumed their careers."

Kelvin Hayden.

IR'd with a neck injury late last season.

And while he's made a roster, there are some yellow flags waved. The Bears and Redskins took a look at him and each supposedly passed because of his previous injury and/or where he was in recovery. Also, could it possibly be that we made the call to release him not just because of his salary, but because the injury and ensuing surgery were going to leave him less than 100% for the remainder of his career?

Hayden, as I recall, had his surgery before the end of the season last year. If he showed up to the Bears and the Redskins still not fully fit that's well out of the purported 2-3 months recovery time... Pure speculation, but it's not at all out of the question...

I'm stretching my mind to think of who else could have had it, and the only name I can think of would be Charlie Johnson, who I believe spent weeks on the injury report with a neck or back issue... If anyone else has any ideas who it may have been, feel free to throw your idea out there because it might help us figure out around what we can expect with recovery...

Which begs the question: did the Colts not re-sign Hayden and (I forget the name of the other guy; wasn't it a backup TE?) because of that surgery?

[John Waylon]

Which begs the question: did the Colts not re-sign Hayden and (I forget the name of the other guy; wasn't it a backup TE?) because of that surgery?

We cut Hayden. His salary wasn't indicative of what he was producing, which seems to be the most likely cause for his release, but the vast majority of his deal was guaranteed, so we really don't save a ton on cap.

But when you think about the way things happened, it does make some sense... Hayden gets injured and has the surgery. We find out that he won't fully recover from it, and we decide to cut him even though it doesn't save us a ton. He goes to Washington and the Bears (he was a PERFECT fit for the Bears) and each team passes on him reportedly due to the injury he suffered last season.

It's definitely something to consider... Not saying the same will happen to Manning, but we could have a confirmed case of a player undergoing this procedure and coming back as less a player than he was before...

As for the other player who had one, I am unsure... I'd like to know though... I really would.

[doogansquest]

I agree...if Peyton is IR'd or God forbid, forced to retire...we shouldn't intentionally tank the season. And no one would be happier than me for the Colts to pull a "Jeff Hostetler" and shock the world with a Super Bowl win led by a backup QB.

But realistically, in looking at our schedule...I think we go 7-9, at best. And 4 of those victories assume we sweep Tennessee and Jacksonville....which we often struggled to do WITH Peyton. Cleveland, Cincinnati and Carolina look weak and beatable...but without Manning all bets are off. So unfortunately....a 3-5 win season is not out of the realm of possibility.

I'm not a "sky is falling" type of person...but if we are looking at a situation where we wind up at or near the top of the draft, with Peyton's health uncertain...then the front office has an obligation to go all out for Andrew Luck.

They have no such obligation to do anything like that, especially since we simply don't have the picks and/or trade value in player stock to get him. There's no way a perennial loser drafting near the top is going to pass on landing Luck, and they certainly aren't obligated to trade that pick to us. Furthermore, Wuerffel, Leaf, Grossman, Leinart, etc., were all amazing QB's in college. There are no guarantees with a draft pick.

[doogansquest]

We cut Hayden. His salary wasn't indicative of what he was producing, which seems to be the most likely cause for his release, but the vast majority of his deal was guaranteed, so we really don't save a ton on cap.

But when you think about the way things happened, it does make some sense... Hayden gets injured and has the surgery. We find out that he won't fully recover from it, and we decide to cut him even though it doesn't save us a ton. He goes to Washington and the Bears (he was a PERFECT fit for the Bears) and each team passes on him reportedly due to the injury he suffered last season.

It's definitely something to consider... Not saying the same will happen to Manning, but we could have a confirmed case of a player undergoing this procedure and coming back as less a player than he was before...

As for the other player who had one, I am unsure... I'd like to know though... I really would.

The skill requirements are also far different for CB than they are for DB. We don't need Peyton to run fast, stop and start, jump, or do any of the things required of such and athletic position. We need his brain to connect with his arm properly.

[John Waylon]

The skill requirements are also far different for CB than they are for DB. We don't need Peyton to run fast, stop and start, jump, or do any of the things required of such and athletic position. We need his brain to connect with his arm properly.

Sure, but it doesn't change the fact that recovery is not a given.

[nsurg]

I'm sorry if I overpost on this, but there has been an awful lot of garbage and speculation in this thread, and even from media medical "experts" that is horribly misleading. I just wanted to give my opinion on what is sadly another surgery.

My background: I'm a neurosurgeon, specializing primarily in complex spine and minimally invasive surgery. I'm a colts fan, and I trained in Indianapolis with a large group of MDs, some of whom currently cover the colts as neurosurgeons. I know Fessler somewhat, and have a great amount of respect for his skill and humility. I have not contacted any doctors involved with manning's care--it's not appropriate to ask them.

Here's my long winded take on this:

Surgery #1 was for nerve decompression with "pain" only, no weakness or numbness. While uncomfortable, it is an optional surgery. The joint was decompressed from a posterior minimally invasive approach by Richard Fessler, a Chicago neurosurgeon who is widely respected in neurosurgery and an early leader in modern minimally invasive surgery. No disc work was done, likely because joint work alone could suffice.

Surgery #2 was, as far as I can gather from the press, for nerve compression at a different position. Manning's incisions are on the right side which, for this procedure, decompresses a never for his throwing arm. His triceps were weak preop and did not fully improve yet. This would mean a right C6-7 compression with disc as part of the compressive component. Nearly every layperson gets this done, if disc is the culprit, from an anterior approach which works well but necessitates fusion (most common) or artificial disc (less common) to "fill in" the gap from removing the entire disc. High-end athletes will sometimes have the disc removed from posterior, which is harder technically and may allow for residual or recurrent compression, but it doesn't require fusion, which makes it more desirable for the athlete. Why didn't it work? Well, the decompression was probably excellent, but the nerve apparently didn't recover. I usually counsel patients that the longer it is compressed and the worse the symptoms are, the longer it takes to recover and the less complete the recovery. I think recovery can take weeks to months, and probably plateaus around 6-12 months postop. The initial trend for recovery continues for a while, but it can be slow. Some people have pain and numbness completely resolve, but still have residual weakness. This is obviously devastating on a high-end athlete if the muscle is useful to the sport, whereas normal patients tolerate mild weakness much better.

Surgery #3 was perhaps a bailout... it ensures excellent, comprehensive decompression, but requires artificial disc (no track record in athletes) or fusion (using usually banked human donor bone, or a bit less commonly a plastic cage packed with bone derivatives). The bone or plastic cage is nearly always "locked" in place with a plate in front with screws, or derivatives of that hardware. It is unclear if manning had residual or recurrent compression, or if the lack of recovery forced some additional action. It can be very difficult to interpret a postoperative MRI, so things get subjective here. For what it's worth, I have no idea who did surgery #3. The first surgery is "easy" for any modern/current surgeon who has bothered to learn minimally invasive techniques, the second is a bit more challenging, and the third is surgery that has been done forever and is perhaps the most common neck surgery done in this country.

For better or worse, the skill of the surgeon, given at least an average level of competence, has very little to do with the prognosis for nerve recovery. Despite all technology, there's nothing proven to "hurry up" nerve healing--one must simply wait and see the progress and trends. Phys therapy does not hasten recovery, but ideally keeps function as good as possible in the muscle until the nerve can allow it to function again.

The prognosis is unclear without knowing every detail, which is not in the media, and even then the prognosis is difficult to determine.

From a "healed from surgery" standpoint, the fusion surgery is safe for a desk job in 2-7 days, safe for a moderate labor job in perhaps several weeks, and safe for heavy labor in 6-12 weeks. I would consider football more than heavy labor--neurosurgical literature generally agrees that an NFL player is safe to play after robust bone fusion has occurred across the graft. Even in a healthy person, the earliest I expect to see the start of fusion is in about 3 months, but "fusion" is defined in different ways. A robust, strong fusion would be rare before 6-12 months in a healthy person. Considering the potential for impact in football, I have a very hard time imagining that manning is declared safe for football this season. Conversely, given the health of an athlete, I would be shocked if he was not "safe" by next year. Sorry, I just don't see him playing this year after a fusion today... if he is playing this season, it is simply because he and the team admin will be pushing very hard to find at least one MD who mildly agrees to let him. While I would love to see him play, there is no possibility he will have a robust bone fusion this season, so any playing time for him would be a bit (?) scary this year.

Perhaps more concerning, however, is his triceps weakness on the right. I have no idea if he recovered any strength or not after surgery #2... but if not, I'm very worried. To lose only a fraction of strength for him would mean amateur-grade velocity for passing, which I'm not sure will cut it. There are 16 nerves in the neck, and just his luck that the right C7 is compressed (though C7 is among the most common to have problems). While he could be completely "safe" to play with a prior nerve injury, the fundamental question is will he be able to throw the ball at full speed? I hate to be a pessimist, but there is at least some chance he does not play at a high level ever again. Conversely, if he has velocity he may simply play perfectly. I can almost promise you that there is not "specialist" aware of his case who truly knows the answer to this yet, and even if they do down the road (i.e. no improvement in strength in the next 2-3 months), would you like to be the guy to tell that to one of the highest paid athletes in the world?

On a side note, C7 numbness, if present, usually involves the middle finger and perhaps 2nd and 4th. Would numbness there affect ball handing? Perhaps a former qb around here could comment.

Sorry for the length of this post, but I hadn't really seen much more than speculation and pseudoscience in this post. Even ESPN and sports illustrated seem to have doctors quoted who don't elaborate enough or who simply don't know what they are talking about. This is pretty basic stuff for anybody who stays current in spine surgery.

At least we have a legit reason why Indy may miss playing at home for the superbowl this year (looking at you, Dallas).

Bottom line: the best news we can hope for is a report that his strength is "improving" at least any amount over the next 4-8 weeks, but even then my opinion is he won't/shouldn't play this year to let the fusion heal... Just be sure to differentiate recovery in bone from recovery in strength--the first is almost guaranteed and the second we simply hope for.

[pacolts56]

They have no such obligation to do anything like that, especially since we simply don't have the picks and/or trade value in player stock to get him. There's no way a perennial loser drafting near the top is going to pass on landing Luck, and they certainly aren't obligated to trade that pick to us. Furthermore, Wuerffel, Leaf, Grossman, Leinart, etc., were all amazing QB's in college. There are no guarantees with a draft pick.

Well....we may not need THAT much in the way of picks/trade value if our record is bad enough, and my premise was if the Colts finish with a record "at or near" the top of the draft....meaning pick 2 or 3.

If we do wind up drafting 2nd or 3rd in the draft, given what we now know about Peyton's health, I would want the front office to pursue Andrew Luck as aggressively as we can. By all accounts...Luck's combination of passing skills, mobility, decision-making and intangibles are far better than the guys you mentioned, and he's being described as the surest thing since Peyton himself.

Does that guarantee anything?....of course not. Do I think we're doomed to a Top 3 draft pick? I hope not...but we are in uncharted territory, aren't we? And if someone like Seattle or Miami is picking 1st, then yes, they'd be foolish to trade the pick. But IMO, a shot at a franchise QB is absolutely well worth taking if we do crash and burn without Peyton this year.

The Colts have flourished on Peyton's shoulders, and if an opportuntiy under the current circumstances arises for a very promising successor to be drafted...yes, earlier than we'd all hoped...then I believe the front office without question has the obligation to the franchise and its fans to make every effort to do so.

One thing is certain. If any NFL owner in league history has realized the value of a successful franchise QB....on the field and on the P&L statement...its Jim Irsay.

[pacolts56]

Sorry for the length of this post, but I hadn't really seen much more than speculation and pseudoscience in this post. Even ESPN and sports illustrated seem to have doctors quoted who don't elaborate enough or who simply don't know what they are talking about. This is pretty basic stuff for anybody who stays current in spine surgery.

Thanks for your insight and expertise...very interesting, even if the news isn't great.

I have neither a medical or football background...but 3 surgeries in that short a timespan sure sounded bad.

[BleedthisBlue]

Wow... What ever happened with genuine human concern for peyton manning the man? I'm as die hard a football fan and sport fan as you will find but in all honesty his contract and future as a qb mean little as to what health issues the man could face in the future, being a new father is far greater a task than ever buckling a chin strap could ever be. If his injuries prevent him from ever taking another snap as a colts fan I am proudly happy to say WE got to cheer for the greatest to EVER play. If he does come back I hope its 100%! But simply disregarding his health and possible use of a limb just to try and comeback for a few games? Thats lunicy! Get well soon peyton your fans support you, having undergone cervical injury from crashing racecars and playing football myself I know how hard it can be to perform at a high level from arm numbness, I cant believe how great he has played since 06 with this issue.

We as fans need to circle the wagons and cheer our colts loud and proud! Get Well soon PM!

[presto123]

Wow. Didn't expect to hear from a neurosurgeon in this thread. Thanks for the info. I definitely agree it is too risky to bring him back this year. Hopefully his recovery goes well and makes him even hungrier when he does come back.

[Jason_]

Awesome post nsurg...thanks for the detailed information.

As I've said before, I in no way want to see Peyton rush back and I don't believe that he nor the Colts FO would try to do that. However, at this point in the season, there's no reason to rush to put him on IR. The only thing we gain from it is an additional roster spot and I can't think of anyone available right now that we would want badly enough to put Peyton on IR right now. Now if at any point they get the impression that there's no chance for him to return to 100% at any point this season, or if we hit 8 losses then by all means go ahead and put him on IR. But as long as we're not yet eliminated from the playoffs and as long as there is even a slight chance that he could reach 100% then there's no need to put him on IR just yet.

[MAC]

Surgery #2 was, as far as I can gather from the press, for nerve compression at a different position. High-end athletes will sometimes have the disc removed from posterior, which is harder technically and may allow for residual or recurrent compression, but it doesn't require fusion, which makes it more desirable for the athlete. Why didn't it work? Well, the decompression was probably excellent, but the nerve apparently didn't recover.

Surgery #3 ensures excellent, comprehensive decompression, It is unclear if manning had residual or recurrent compression, or if the lack of recovery forced some additional action.

Perhaps more concerning, however, is his triceps weakness on the right. I have no idea if he recovered any strength or not after surgery #2... but if not, I'm very worried.

Thank you so much for your willingness to share your knowledge, and for taking the time to post this.

Follow up questions if you can. I understand that you can't diagnose from a distance - it isn't my intention to ask for more than general guidelines and informal conjecture.

1) When you say that you read that the second surgery was for nerve compression at a different position, are you talking about a different disk? I keep hanging my hat on the FO statement that arthritic degeneration wasn't an issue for Peyton, and therefore hoping that he has an isolated problem. But if the first two surgeries were on two different disks, wouldn't that be far more concerning long term.

2) What do these surgeries from the rear of the neck actually entail? Partial disk removal to make room for the nerve or something? I didn't think that you could remove the whole disk without the necessity of filling the space/fusing.

3) I was told when debating whether to have fusion surgery that "if you wait more than 90 days you risk permanent nerve damage". It's seemed logical to assume that with all the resources available to Peyton he wouldn't "wait too long", but I've read some articles suggesting that this has been lingering for years. Can you clarify which symptoms indicate that a nerve is actually in the process of being damaged, and do you recall reading anything as this problem has evolved over the past year or two that would allow some conjecture about when the damaging compression occurred? I realize that this is awfully close to asking "did he wait too long to have surgery"? I know that you can't answer that specifically for a variety of reasons - just looking for general info and public statements that might be relevant. With all this in mind how would the wait between the second and third surgeries - if it were to turn out that the nerve is still impinged - affect his prognoses?

4) I had assumed from the timing of the third surgery that the nerve was still impinged. If in fact the odds are that the "decompression was probably excellent", what other types of issues might have necessitated the third surgery. Or is it more likely to be a matter of "it's not getting better and this is the only thing left that might help"?

I apologize if any of this pushes you outside your comfort zone. Don't know until you ask.

[Ego]

Absolutely devastated. I want success because I feel Peyton deserves it.. but man, I could care less about the accolades. I just want to see the greatest QB on earth playing football. Football without Manning, Is like Golf without Tiger.. well maybe not that bad.. but darn near close.

Praying everyday for you Peyton. Colts fans should do the same.. truely, there is power in prayer..

[ruksak]

Absolutely devastated. I want success because I feel Peyton deserves it.. but man, I could care less about the accolades. I just want to see the greatest QB on earth playing football.

I know. Manning is being so selfish right now. We should cut him.

there is power in prayer..

You do that and I'll perform a satanic ritual to invoke the power of Beelzebub, the dark overlord of Hades. The combination of prayer and the invocation of ancient satanic rituals should be enough to get Manning back in a few weeks.

[John Waylon]

truely, there is power in prayer..

Well there's also (more) power in shooting up bull rhinoceros testosterone...

I vote for my option...

[everybodysgotone]

Praying everyday for you Peyton. Colts fans should do the same.. truely, there is power in prayer..

This ^ is very appropriate. It's the best thing any of us can do on behalf of a person. Lets not forget Jim Irsay giving the SB victory over to the glory of God.

[ruksak]

This ^ is very appropriate. It's the best thing any of us can do on behalf of a person. Lets not forget Jim Irsay giving the SB victory over to the glory of God.

With all due respect, while it may be appropriate to do in ones own privacy, espousing ones religious beliefs on this forum is not appropriate. Nor do I find it appropriate for Irsay or any other prominent figure in sports to take advantage of his platform to spread belief in his religion.

If y'all wanna pray for Peyton, do so, but keep that crap off of my football page. I do not come here to be exposed to individual belief systems. There are many, and I seriously doubt that y'all wanna hear my take on Christ.

If Irsay had granted favor to Buddha, Allah or any other deity, the backlash would have been noticeable. It is disrespectful to myself and many others when people bear witness to god in such a public manner. The irony being, many people are probably receiving my retort as disrespectful toward their religion. How ironic indeed.

To avoid this unpleasantness, it is best to omit ones religious practices from this forum altogether.

[braveheartcolt]

With all due respect, while it may be appropriate to do in ones own privacy, espousing ones religious beliefs on this forum is not appropriate. Nor do I find it appropriate for Irsay or any other prominent figure in sports to take advantage of his platform to spread belief in his religion.

If y'all wanna pray for Peyton, do so, but keep that crap off of my football page. I do not come here to be exposed to individual belief systems. There are many, and I seriously doubt that y'all wanna hear my take on Christ.

If Irsay had granted favor to Buddha, Allah or any other deity, the backlash would have been noticeable. It is disrespectful to myself and many others when people bear witness to god in such a public manner. The irony being, many people are probably receiving my retort as disrespectful toward their religion. How ironic indeed.

To avoid this unpleasantness, it is best to omit ones religious practices from this forum altogether.

"Amen" to that sir.

[geinsteder]

Thank you for the excellent post. Neurosurgery! I'm a pacu/er nurse and have been listening to the different media stories over the past few months. My heart has always been wanting to see him play. My head has told to think more practically. I have rarely seen a person go through neck/back surgery with 100% success. From what I have seen it's a last ditch effort to get the patient as back to normal as you can be be able to function with your ADLs. Now playing football at his level I think will take a act of god to get him back to that time in his life. Miracles do happen though.

Sounds like he has been dealing with this awhile though. God bless him and his family.He is a brand new father and needs to think about what's best for them. he has given so much to this game we call football.

[Restored]

If Peyton comes back this year and destroys everyone these last 4-5 weeks of the year and the Colts go on a run, sooooooo many people are gonna be . Just ride it out and see if he can come back, who knows if we are sitting in a possible playoff spot, we could go on a run. Have faith.

[pacolts56]

With all due respect, while it may be appropriate to do in ones own privacy, espousing ones religious beliefs on this forum is not appropriate. Nor do I find it appropriate for Irsay or any other prominent figure in sports to take advantage of his platform to spread belief in his religion.

If y'all wanna pray for Peyton, do so, but keep that crap off of my football page. I do not come here to be exposed to individual belief systems. There are many, and I seriously doubt that y'all wanna hear my take on Christ.

If Irsay had granted favor to Buddha, Allah or any other deity, the backlash would have been noticeable. It is disrespectful to myself and many others when people bear witness to god in such a public manner. The irony being, many people are probably receiving my retort as disrespectful toward their religion. How ironic indeed.

To avoid this unpleasantness, it is best to omit ones religious practices from this forum altogether.

C'mon ruksak, do you have to throw a grenade like that?

You could've simply posted this....

Forum Rule #5

Debates/discussions involving race, religion, politics, etc. *ALWAYS* spiral out of control and really have no place on a FOOTBALL forum. So please refrain from such 'hot' topics here.

I must admit though...I'm curious about Forum Rule #5 i.e. Constitutional free speech/press rights....which I believe protect both Jim Irsay's public comments praising God and would equally protect your public pledge of allegiance to the devil, and just as equally would protect the comments of everyone from that clueless charlatan in the White House to the incompetent teabaggers in Congress who hate him....as well as the keyboard rantings of mongoloids like us.

We've already heard very informatively from a neurosurgeon....so, as Billy Ray Valentine once asked....is there a lawyer in the house??!! lol

Scratch that....maybe we oughta just "refrain" and get back to Peyton's neck.

[ruksak]

Scratch that....maybe we oughta just "refrain" and get back to Peyton's neck.

I believe this would be the proper course of action.

hail satan

[Restored]

Enough with the religious stuff already please. The users that were referencing prayers toward Peyton and his injury were more or less just wishing him well. Don't overblow it please.

On topic however, Peyton will be back week 11, quote me.

[Yehoodi]

With all due respect, while it may be appropriate to do in ones own privacy, espousing ones religious beliefs on this forum is not appropriate. Nor do I find it appropriate for Irsay or any other prominent figure in sports to take advantage of his platform to spread belief in his religion.

If y'all wanna pray for Peyton, do so, but keep that crap off of my football page. I do not come here to be exposed to individual belief systems. There are many, and I seriously doubt that y'all wanna hear my take on Christ.

If Irsay had granted favor to Buddha, Allah or any other deity, the backlash would have been noticeable. It is disrespectful to myself and many others when people bear witness to god in such a public manner. The irony being, many people are probably receiving my retort as disrespectful toward their religion. How ironic indeed.

To avoid this unpleasantness, it is best to omit ones religious practices from this forum altogether.

nothing personal Ruksak, but as I agree with you regarding ones relaying religous believes on forum boards, i whole heartly and respectfully disagree with you regarding how ones conveys their thoughts publicly, if they wish to thank "my family," "my trainers," "my teammates," "the inspriation from the kid dying of cancer at the cancer hospital," "my God given talent," or "Jesus my savior" . . . or whatever or whomever, that is their inherent right to do so . . . and it is not for me (or anyone) to question from which they get their inspiration or drive to compete in a given venue, be it sports or otherwise . . . it is not for us to cherry pick and asks others to refrain from thanking selected aspects of their life . . .

[pacolts56]

Peyton will be back week 11, quote me.

I know we all wish Peyton well.

[Yehoodi]

I just want to say that I wish Peyton a swift and healthy recovery from his surgery . . . and wish him the best of luck . . . first and foremost a healthy recovery that will not effect the rest of his life style and second a recovery that will help in get back to playing football, his passion in life . . .

[John Waylon]

I believe this would be the proper course of action.

hail satan

?

[ruksak]

?

Best Xmas special ever.

Yehoodi Wrote:

nothing personal Ruksak, but as I agree with you regarding ones relaying religous believes on forum boards, i whole heartly and respectfully disagree with you regarding how ones conveys their thoughts publicly, if they wish to thank "my family," "my trainers," "my teammates," "the inspriation from the kid dying of cancer at the cancer hospital," "my God given talent," or "Jesus my savior" . . . or whatever or whomever, that is their inherent right to do so . . . and it is not for me (or anyone) to question from which they get their inspiration or drive to compete in a given venue, be it sports or otherwise . . . it is not for us to cherry pick and asks others to refrain from thanking selected aspects of their life

Agreed. I suppose if Irsay wants to thank a flying spaghetti monster for the SB he can do so. I'm gettin outta this conversation though, I think I made my point. I am a tad hyper sensitive about this due to having to work many years ago in close quarters with people that would constantly bear witness to Jesus and the scripture. I asked them to please stop and they continued. I finally told them what I thought of their beliefs and I got fired for it. The reason; insulting my co-workers religious beliefs. Even though they insulted my beliefs by saying, and I quote "We don't want you to burn for eternity" while bearing witness.

Anywho...I'm leaving this thread as moderation is soon to come.

[Yehoodi]

C'mon ruksak, do you have to throw a grenade like that?

You could've simply posted this....

Forum Rule #5

Debates/discussions involving race, religion, politics, etc. *ALWAYS* spiral out of control and really have no place on a FOOTBALL forum. So please refrain from such 'hot' topics here.

I must admit though...I'm curious about Forum Rule #5 i.e. Constitutional free speech/press rights....which I believe protect both Jim Irsay's public comments praising God and would equally protect your public pledge of allegiance to the devil, and just as equally would protect the comments of everyone from that clueless charlatan in the White House to the incompetent teabaggers in Congress who hate him....as well as the keyboard rantings of mongoloids like us.

We've already heard very informatively from a neurosurgeon....so, as Billy Ray Valentine once asked....is there a lawyer in the house??!! lol

Scratch that....maybe we oughta just "refrain" and get back to Peyton's neck.

the Constitution rights only protect us against acts by the Government; essentially, the Constitution established the govenment giving it powers as well as limitations, with the limitations being you can't do a, b, or c against us (chill our free speech for example) . . . the these rights do not protect us against individuals or groups, unless some how the group is indirectly tied to the State . . . so a group could prevent us exerciting our freedon of speech , i.e. no religous talk on this forum . . . however state and federal laws will apply to individual groups and people . . . for example the federal anti-dscrimination laws could prevent a forum like this if it had a policy of not allowing posters from a given race to join the forum . . .

[Girlzarefanstoo]

Ruksak;

Sorry you were harrassed in the name of Christ - I'm a Christian and wouldn't have done so as would most others. You have a right to not believe if you choose and I respect that right. We'll just leave it off there. Just wanted you to know your right to not believe is as sacred to me and others as our right to believe.

As to Peyton's neck, as I've personally seen miraculous healing occur from time-to-time, I will be praying for his recovery.

Peace,

Audrey

[Yehoodi]

Best Xmas special ever.

Agreed. I suppose if Irsay wants to thank a flying spaghetti monster for the SB he can do so. I'm gettin outta this conversation though, I think I made my point. I am a tad hyper sensitive about this due to having to work many years ago in close quarters with people that would constantly bear witness to Jesus and the scripture. I asked them to please stop and they continued. I finally told them what I thought of their beliefs and I got fired for it. The reason; insulting my co-workers religious beliefs. Even though they insulted my beliefs by saying, and I quote "We don't want you to burn for eternity" while bearing witness.

Anywho...I'm leaving this thread as moderation is soon to come.

Ruksak, sorry to hear about your coworkers and being fired . . . i guess we are on opposite ends, I have a collegue in my office that is the opposite of your prior coworkers, she wants religon taken out of everything, any time some one mentioned religon she has a tissy . . . couple that with some of the stuff going on in this country, i guess i am a tad hyper sensitive in the other direction . . .

but i think you and I are fine . . .

[Nadine]

Pehaps it would be best if you just understood that they are wishing Manning a speedy recovery and not making any attempt to force religion on anyone.

With all due respect, while it may be appropriate to do in ones own privacy, espousing ones religious beliefs on this forum is not appropriate. Nor do I find it appropriate for Irsay or any other prominent figure in sports to take advantage of his platform to spread belief in his religion.

If y'all wanna pray for Peyton, do so, but keep that crap off of my football page. I do not come here to be exposed to individual belief systems. There are many, and I seriously doubt that y'all wanna hear my take on Christ.

If Irsay had granted favor to Buddha, Allah or any other deity, the backlash would have been noticeable. It is disrespectful to myself and many others when people bear witness to god in such a public manner. The irony being, many people are probably receiving my retort as disrespectful toward their religion. How ironic indeed.

To avoid this unpleasantness, it is best to omit ones religious practices from this forum altogether.

[Nadine]

All fighting about religion needs to stop now. It's off topic

[#1 Colts Fan]

Get well soon Peyton we will miss you :ref:

[shecolt]

@ Falcons_Guy, Girlzarefanstoo, ViriLudant, Yehoodi, and any other members I may have missed who are fans of another team; I would like to thank you for your kind words.

I have many friends (who are fans of other teams) on Facebook and they are taking great delight in the news about Peyton.

I find that sad. Even though I have no love for Tom Brady and the Patriots, I felt very bad for him and the Patriot fans when he was injured and out for the year.

How any fan can take delight in the injury of a player from another team is beyond me.

[presto123]

@ Falcons_Guy, Girlzarefanstoo, ViriLudant, Yehoodi, and any other members I may have missed who are fans of another team; I would like to thank you for your kind words.

I have many friends (who are fans of other teams) on Facebook and they are taking great delight in the news about Peyton.

I find that sad. Even though I have no love for Tom Brady and the Patriots, I felt very bad for him and the Patriot fans when he was injured and out for the year.

How any fan can take delight in the injury of a player from another team is beyond me.

Well said. I don't want to see anybody get hurt and like you said when Tom Brady was out the league wasn't quite the same just as it won't be this year.

[GoColts8818]

http://espn.go.com/nfl/story/_/id/6949481/doctors-say-peyton-manning-neck-surgery-went-very-well

If that has been posted I am sorry but they say it went well. I'll take any good news I can get at this point.

[nsurg]

Thank you so much for your willingness to share your knowledge, and for taking the time to post this.

Follow up questions if you can. I understand that you can't diagnose from a distance - it isn't my intention to ask for more than general guidelines and informal conjecture.

1) When you say that you read that the second surgery was for nerve compression at a different position, are you talking about a different disk? I keep hanging my hat on the FO statement that arthritic degeneration wasn't an issue for Peyton, and therefore hoping that he has an isolated problem. But if the first two surgeries were on two different disks, wouldn't that be far more concerning long term.

2) What do these surgeries from the rear of the neck actually entail? Partial disk removal to make room for the nerve or something? I didn't think that you could remove the whole disk without the necessity of filling the space/fusing.

3) I was told when debating whether to have fusion surgery that "if you wait more than 90 days you risk permanent nerve damage". It's seemed logical to assume that with all the resources available to Peyton he wouldn't "wait too long", but I've read some articles suggesting that this has been lingering for years. Can you clarify which symptoms indicate that a nerve is actually in the process of being damaged, and do you recall reading anything as this problem has evolved over the past year or two that would allow some conjecture about when the damaging compression occurred? I realize that this is awfully close to asking "did he wait too long to have surgery"? I know that you can't answer that specifically for a variety of reasons - just looking for general info and public statements that might be relevant. With all this in mind how would the wait between the second and third surgeries - if it were to turn out that the nerve is still impinged - affect his prognoses?

4) I had assumed from the timing of the third surgery that the nerve was still impinged. If in fact the odds are that the "decompression was probably excellent", what other types of issues might have necessitated the third surgery. Or is it more likely to be a matter of "it's not getting better and this is the only thing left that might help"?

I apologize if any of this pushes you outside your comfort zone. Don't know until you ask.

1) To be honest, I may be totally off about every medical "detail". I have seen many medically conflicting reports, so it's hard to know which. I gather it was a different level the 1st time but I might be wrong. I also had the impression that it was not a discectomy last time but other vague reports conflict. A discectomy requires a more gentle return to activity to avoid reherniation, so that's where I made some perhaps incorrect assumptions.

2) In essence, the goal of any of these surgeries is very simple: decompress the nerve. What you must remove to accomplish this is dependent on the approach and the details of what is causing the compression. From a posterior cervical approach it is hard to remove much disc as you can't retract spinal cord, and more importantly you don't need to remove much disc. From an anterior approach you remove so much disc that the entire thing is usually removed; the space is then filled with fusion>artificial disc.

3) Complex to answer this. In short, pain is never "nerve damage"--think of it as inflammation of a sensitive structure. Numbness or weakness or clumsiness is nerve dysfunction; when it is not transient but is a fixed deficit I suppose you could call that nerve "damage". If a patient doesn't mind the deficit, then they are welcome to ignore it, but should not expect that a year later they will show great recovery. Again, the worse the deficit x the duration of deficit seems to correlate with less final recovery and slower recovery, but things are still unpredictable. For the average person there is only one surgery that you probably "should" have even if you don't want it--fixing a compressed spinal cord when there are symptoms. For nerve compression of the neck or for lower back surgery, there is no "should" for surgery, but the better question is whether or not there is an option to have surgery. The skill for my practice is communicating to patients what symptoms will respond (and what likely will not), the chance of response, and what the alternatives are. If a surgeon doesn't communicate this to you but coerces you to have surgery, walk out of the room.

For peyton, I have not yet seen the duration of his weakness or any discussion of the relative severity of his weakness; nor have I seen much discussion as to the presence/absence of recovery postop.

4)No idea on this one. I suppose there was either recurrent or residual compression as a probable or maybe status (the postop MRI is very subjective to interpret)... or else it was simply desperation.

Thank you for the excellent post. Neurosurgery! I'm a pacu/er nurse and have been listening to the different media stories over the past few months. My heart has always been wanting to see him play. My head has told to think more practically. I have rarely seen a person go through neck/back surgery with 100% success. From what I have seen it's a last ditch effort to get the patient as back to normal as you can be be able to function with your ADLs. Now playing football at his level I think will take a act of god to get him back to that time in his life. Miracles do happen though.

Sounds like he has been dealing with this awhile though. God bless him and his family.He is a brand new father and needs to think about what's best for them. he has given so much to this game we call football.

Spine surgery is perhaps one of the most misunderstood types of surgery in this country. There certainly are bozos out there trying to do the most expensive surgery they can conceive on every patient who comes through the door. Unless you are 16 years old, you will always have at least some arthritis on your MRI--no big deal. See point (4) above. The aggressive or coercive surgeons, exemplified but not exclusive to the laser quacks and the fuse every lumbar spine folks, will have poor outcomes unless placebo concepts apply, and these folks probably destroy the reputation of spine surgery. Conversely, I will seldom operate unless a patient understands exact goals of surgery and my feeling is that we have a good to excellent chance of achieving those goals. Any reasonable spine surgeon should be able to say the same thing in my opinion. If you ever are told you "need" a surgery, ask why... if you don't trust things, get 2-3 total opinions and do with whomever wants to do the least. A friend will always want to believe they went to the best person in the world, so take that with a grain of salt. In short, I expect my patients to do great after surgery and have had skiers and marathon runners who are eventually able to return to those activities without compromise. There are always those who don't do as well as desired, but they are in the distinct minority. It is often successful to improve leg and arm pain from pinched nerves, but virtually impossible to eliminate arthritic neck and back pain with surgery. I hope I'm not on my soapbox too much right now, but I really get frustrated with all the gimmicks/scams/misconceptions in the world of spine medicine, and it disgusts me when people are misled.

Back to manning: let's just hope that by 6-12 weeks after this surgery we hear that he can throw with velocity--nothing else matters for his career relative to these surgeries.

[MAC]

If a surgeon doesn't communicate this to you but coerces you to have surgery, walk out of the room.

I will seldom operate unless a patient understands exact goals of surgery and my feeling is that we have a good to excellent chance of achieving those goals. Any reasonable spine surgeon should be able to say the same thing in my opinion. if you don't trust things, get 2-3 total opinions and do with whomever wants to do the least.

Once again we appreciate your time. On the bright side, I'm sure anyone reading this feels much more realistically informed about Peyton's possible outcomes. I'm completely comfortable with him missing the entire season, and hope that he makes a decision based on his long term health, not his desire to compete.

On the other side (for me personally), I have good reason to suspect that my surgery (2005 C5-6) would have been postponed if I had had a surgeon with your sense of integrity and willingness to communicate. Too late now, but if there is a next time I will do surely do some serious evaluation - even if pain is eroding my judgement.

At risk of abusing your good graces: The more that I hear about Peyton's post surgery workout regimes, the more I think that there must be exercises I should be doing to protect my mildly arthritic neck from unnecessary strain. I feel like a 98 pound weakling at this point, and I'm concerned about exacerbating the problem if I invent my own protocol. Should I see a specialist or someone and ask for a plan, or am I over-thinking it.

Thanks again for your words of wisdom.

[Peyton and Eli fan]

Here's an article talking about the timeline. Explains why he waited until May to get the 1st surgery.

http://blogs.indystar.com/philb/2011/09/11/clearing-up-facts-on-manning-surgery-timeline/