(Photo by Keith Allison found here on flickr.com)
Why his decision might impact you
Texas Rangers first baseman Prince Fielder, who came to the club in a much discussed trade for longtime Ranger and All-Star Ian Kinsler in the offseason, is done for the year. According to ESPNDallas.com and other sports media, he had cervical fusion of the C5/6 discs in his neck on May 27th in Dallas. As the club indicated last week, he's expected to miss the rest of the 2014 season.
While this turn of events is bad news for the Rangers, already reeling from the loss or several other players, it has also spawned a new round of controversy. This time the discussion is about whether the spine fusion procedure was the correct call for the player’s short-term and long-term health and career. Should Fielder have chosen a more high-tech, albeit newer procedure – artificial disc replacement?
Since Texas Back Institute has pioneered many spine surgery techniques including artificial disc replacement, we asked one of its surgical experts, Dr. Michael Hisey, to weigh in on the Fielder’s decision and prognosis.
The Iron Man Goes Down
The season-ending surgical procedure came about when the 30-year old first baseman was unable to play due to a herniated disc in his neck. This injury included weakness in his left arm which is not only frightening but a distinct disadvantage when one’s occupation involves swinging a bat while trying to hit a baseball which is traveling 90 miles per hour!
Up until this injury, Fielder was considered to be one of baseball’s “iron men.” This is the first time he's been on the “Disabled List” in his entire career. According to Major League Baseball, the first baseman ended his streak of 547 consecutive games, the longest active streak in the majors. He had played in at least 157 games in each of his eight seasons with Milwaukee and Detroit prior to 2014.
Advantages and Disadvantages
When a professional athlete opts to have surgery, it is not a casual decision. It could mean an end to his livelihood. We asked Dr. Hisey what the short-term and long-term ramifications of Fielder’s spinal fusion procedure were.
“In the short term, he will have limited ability to participate in sports and athletics,” said Dr. Hisey. “It will take 3 to 6 months to get the bone healed and even though he will be able to walk, he won’t be swinging a bat or sliding into second base. Long-term, his ability to play at the professional level will depend on lots of factors.”
Fielder, his physician and the Texas Rangers decided to pursue the spine fusion option for his injury. What are the advantages and disadvantages of this choice?
“Fusion surgery has been used for 20 or 30 years and it is a reliable way to restore normal function,” noted Dr. Hisey. “His arm weakness should go away because the pressure will be taken off the nerve. This procedure has been performed with other professional athletes such as Peyton Manning and they were able to get back to action.”
In looking at the disadvantages of fusing vertebra, Hisey said, “This procedure stops the motion in that area by stiffening the area placing more stress on the discs above and below. This can cause increased wear and tear and degeneration of the discs over time.” Research shows fusion can lead to as much as twenty-five percent degeneration of the adjacent discs over 10 years,” he said.
“Another disadvantage is long recovery required for fusion surgery,” Hisey noted.
What about artificial disc replacement? What are the pros and cons of this procedure?
“Motion is preserved with artificial disc replacement,” Dr. Hisey notes. “The pressure on the nerve is relieved, so arm strength can be regained and there is not loss of motion and therefore less potential for degeneration of the discs above and below the new disc.”
“The primary advantage of artificial disc replacement is the dramatic difference in recovery time versus the fusion procedure,” Dr. Hisey said. “Had Fielder chosen an artificial disc, he could have been in rehab in 6 weeks and could arguably be playing competitively in 3 months. This means he could have had a chance of being back in the lineup by September,” Hisey concluded.
“Because this is a relatively new procedure, without as much clinical history, some might feel this is a disadvantage,” Hisey said.
Not Everyone is a Candidate
If the two procedures are comparable in terms of successful outcomes and the recovery time is less, why wouldn’t everyone with this type of injury choose the artificial disc replacement route?
“Not everyone is a candidate,” noted Hisey. “Fielder’s doctor may have found that his physical situation is not appropriate for this procedure.”
“A typical soft disc injury or “herniation” is a good candidate for an artificial disc replacement,” said Dr. Hisey. “However, if there is instability at the injured disc level, or if the procedure will require taking too much bone, fusion may be the only option.”
“Other medical conditions can preclude someone from choosing artificial disc replacement,” he said. “Someone with osteoporosis, infection or spinal cord compression is not a good candidate for this newer procedure.”
Most of us are not professional athletes whose career depends on being in superior condition. What about normal men and women who have had injuries or disease which damage discs. Which is the better choice – fusion or artificial disc replacement?
“If one meets the medical criteria noted above, there’s no question which procedure is superior,” noted Dr. Hisey. “Artificial disc replacement is safer, it preserves motion thereby avoiding degeneration of the discs later, there are fewer complications, there is better pain relief and the recovery time is quicker.”
If you are interested in getting more information on artificial disc replacement or have any other questions regarding treatments for back or neck pain, contact us at Texas Back Institute.