Last Friday, Tony Romo underwent surgery for a herniated disk sustained during a game with the Washington Redskins.
It was reported to be a herniated disk at the L4-5 level. In April, Romo underwent surgery for what the Dallas Cowboys called a “spinal cyst” and recovered uneventfully. These cysts are more precisely known as facet cysts and are usually a precursor to a more serious condition, degenerative spondylolisthesis.
Degenerative spondylolisthesis is a genetic condition that develops as we age. Essentially, the disk between two vertebrae begins to degenerate, most commonly at the L4-L5 level. The L4 vertebra then “slips” forward on the L5 vertebra creating a pinching of the spinal canal and nerves. Usually the disk deforms during this process and can easily herniate.
The Dallas Cowboys are reporting that the two injuries are unrelated and Romo should make a full recovery. However, if the cyst and the herniation are at the same level (i.e.L4-L5) this is a sign of instability in the spinal segment. These issues ARE related and could mean that Romo is developing spondylolisthesis, a condition treated with a spinal fusion.
A precursor to this condition is the development of a facet cyst. These cysts develop due to the instability between the vertebrae. The cysts can be easily removed, however they frequently recur and when they do require a lumbar spinal fusion.
If Romo’s cyst and herniated disk occurred at the same level this indicates the instability is getting worse. He has now had both bone and disk removed at the same level and the vicious cycle of instability is underway. A spinal fusion is the next surgical step should he herniated again or develop another cyst.
Spinal fusion in the lumbar spine would be a career ending surgery, much different from the cervical fusion from which Peyton Manning is recovering.
At this point we can only speculate what the exact injuries were since the Cowboys are not releasing any specific information. For Romo’s sake, we hope the injuries are at separate levels and he continues to have a long and productive career.
Dr. Banco is a board-certified, fellowship-trained orthopaedic spinal surgeon. He attended medical school at Jefferson Medical College followed by an orthopaedic surgery residency at Thomas Jefferson University Hospital, both in Philadelphia. Dr. Banco performed his spinal fellowship at The New England Baptist Hospital in Boston, MA.