In the midst of yet another dreadful Sabres hockey season, it was announced Wednesday that star center Jack Eichel would be out for the remainder of the season. He was officially diagnosed with a herniated disc in his neck that will require surgery. This news comes after a hit against the boards on March 7th that appeared to jar his neck, forcing him off the ice since then.
Expecting an update today on Jack Eichel. Word is BUF captain needs surgery and will get it done soon, so he can begin training in preparation for next season. He’ll miss the remainder of this year.— Elliotte Friedman (@FriedgeHNIC) April 14, 2021
The Sabres have gone on to state that they expect Eichel to return fully healthy by the beginning of next season. However, details are scarce regarding the specifics of the surgery and chances for re-injury in the future. Below is the anatomy of the injury, possible surgical procedures, and outcomes for 2021 and beyond.
The neck is made up of 7 cervical vertebrae that allow the spinal cord to pass through the middle, acting as a cage of sorts. In between these vertebrae are intervertebral discs which help provide space for the nerves that branch off the spinal cord to go out to innervate their respective areas of the body. The discs also allow for the movement of the vertebrae over each other. This provides stability around the spinal cord and nerves but also allows for mobility for all neck movements.
When a disc herniation occurs, this is the result of either a traumatic event such as an unexpected blow to the head/neck area or degeneration to the area over time. In the case of Eichel, it appears as the hit to the boards was enough to herniate his disc, though it’s possible he was dealing with this before as he was dealing with an upper-body injury at the beginning of the season. The hit may have made things worse that it was enough to prevent him from playing through the ailment.
"He will be fine. We are just being cautious in the process. We expect Jack in the next couple days here." - Ralph Krueger on Jack Eichel missing opening day with an upper-body injury.— John Vogl (@BuffaloVogl) January 1, 2021
When a disc herniation occurs, the tough outer annulus fibrosus tears, allowing the nucleus pulposus to push out through the tear, which in turn, pushes on either the spinal cord or more likely, the spinal nerve that branches off the spinal cord. That pressure on the nerve can send pain down that nerve pathway, usually into the arm, and cause what is known as radiculopathy. This can be felt as pain, numbness, tingling, and weakness, leading to difficulty with everyday activities. This disc protruding may also limit neck motion or cause significant pain as noted in the video above on Eichel on the bench. Through physical testing, doctors can narrow down what level is affected based on the symptom presentation and use imaging to confirm the diagnosis.
Having any of these symptoms for normal day-to-day life is tough enough; add in the fact that hockey players require incredible vision and constant use of their upper bodies that playing would be very difficult.
He likely attempted to treat this conservatively over the past month with physical therapy, chiropractic care, or even injections to address the complaints. However, the medical team likely looked at the lack of progress and eyeing towards next season, elected to have surgery to address the problem long term. There are a number of different procedures he could have, but it’s possible that he required an anterior cervical discectomy with fusion.
The anterior cervical discectomy with fusion is a procedure in which a surgeon enters the neck anteriorly, near the throat, to remove the herniated disc and fuse the vertebrae that were above and below where the disc was removed. The surgeon fuses this together using a piece of extracted hip bone to create a bony spacer where the disc was prior. The surgeon then places a plate over the front that connects the two vertebrae together to create the fusion.
This reduces the pressure on the cervical nerves, leading to long-term stability. These outcomes are overall very positive with 80 percent of players that have this procedure return to play with no discernible change in the quality of play. Most return to play within 9 months, though this was between a variety of professional sports. Hockey players can return sooner with research indicating that a player in the study returned in 6.7 months, though there is not widespread research regarding the normative values to return in hockey specifically. General rehab protocols allow return to sport at 6+ months, but that timeline could vary based on the doctor and recovery process.
Failure rates for ACDF vary anywhere from 2.1 percent to 9.13 percent for a single level in the general population which is rather low. For athletes specifically, it is reported at 5.8 percent. There is concern that if he does indeed have the fusion to the area, the vertebral segments above and below the surgical sites could be compromised and eventually become injured, though far from a guarantee. In terms of function, Eichel will have no change in rotation of his head with a possible small loss of motion for flexion/extension and sidebending, though the other segments can make up for this loss. In addition, return to contact sports for a single-level fusion is acceptable with no long-term concerns.
There are other possibilities including a discectomy or artificial disc replacement, but discectomies have a chance to re-herniate later on. As for the artificial disc, there are instances where professional athletes have had the procedure, but I am not certain that this is a widespread intervention for athletes at that level. I have also not found research to support that this is superior to the more common anterior cervical discectomy with fusion.
Looking back at everything, Eichel requires surgery to correct the disc herniation and it is likely that he requires the fusion surgery that has excellent outcomes for return to sport. I have little concern health-wise heading into next season or that this will become a recurring issue. I do hope that the Sabres finally find a coach that can utilize all the talent on this roster to restore a once winning tradition and finally get Eichel and the city of Buffalo back to the Stanley Cup playoffs.