Why did Peyton Manning need another physical? The answer: to rule out further deterioration of his neck. Manning underwent a cervical fusion for a herniated disk in 2011. He obviously did well this season, securing another MVP award. However, there is concern the disks above and below the fusion will deteriorate.
This is called adjacent segment degeneration. It is a documented side effect of an anterior cervical fusion. The degeneration occurs in approximately 3% of patients per year undergoing an operation such as Manning’s. Therefore, approximately 25-30% of patients in the ten years following an anterior cervical fusion will require additional surgery at an adjacent level.
Its cause is partially related to the cervical fusion. After the disk is removed, a bone graft is placed between the bones and a plate is applied to the front of the spine. This relieves the pressure of the herniated disk but changes the mechanics of the spine permanently. The disks above and below the fusion bear more stress and breakdown more rapidly. The degeneration is also related to the natural aging process of the spine.
Obviously, the Denver Broncos have a keen interest in the status of Peyton Manning’s neck. Any serious degeneration will create pain and/or weakness in Manning’s throwing arm possibly necessitating another surgery.
From all accounts it appears Manning his fine and the adjacent levels are not deteriorating. For now Manning’s career is safe and he can play another year. However, as each year progresses the incidence of degeneration rises.
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.