As Jermichael Finley lay on the ground motionless in October, Lambeau came to a halt.
The score didn't matter. Neither did football as a whole.
After several minutes, Finley left the field on a stretcher.
Somehow, the game had to go on. Somehow, the players needed to stomach the events that just transpired and press onward.
Fortunately, positive news had already leaked out by the time Finley departed. Tyler Dunne of the Milwaukee Journal Sentinel tweeted that the Packers tight end had movement in all four of his limbs, meaning he avoided an instantaneously catastrophic neurological injury:
Jermichael Finley has a neck injury but does have movement in all of his extremities. #packers— Tyler Dunne (@TyDunne) October 20, 2013
Nevertheless, the next morning, details began to emerge via a number of routes. The most frightening came from ESPN's Chris Mortensen: doctors admitted Finley to the ICU.
Packers TE Jermichael Finley in ICU after his neck injury. He has not had surgery as of early this a.m. and status uncertain. Monitoring.— Chris Mortensen (@mortreport) October 21, 2013
Hospitals reserve the ICU—short for "intensive care unit"—for patients who either require immediate, life-saving therapy or may in the near future.
In other words, something scared the Packers medical staff into thinking their tight end needed constant medical surveillance.
Following head or neck trauma such as Finley's, neck instability due to injured spinal ligaments or broken vertebrae can threaten the integrity of the spinal cord itself.
Neck injuries can also produce significant swelling within the neck or spinal canal—the bony tube formed by the vertebrae that protect and encase the cord.
In the case of a spinal cord contusion, injury to ligaments or soft tissues around the canal cause fluid or blood to accumulate around the cord. If large enough, the fluid collection can press on the cord itself and produce neurological symptoms such as weakness, pain or even paralysis.
In short, Finley had quite the battle to fight.
However, according to NFL.com's Ian Rapoport, by the early afternoon the next day, he was walking and likely soon headed out of the ICU.
Latest on #Packers TE Jermichael Finley: Source says he’ll likely leave ICU today. He’s walking, moving around, in good spirits.— Ian Rapoport (@RapSheet) October 21, 2013
Then, the star himself let his fans know that it was finally time to take a sigh of relief.
Somehow, he also kept a positive attitude through the ordeal.
I was able 2 walk to & from the shower today, which was badly needed after yesterday's victory! Thank u again 4 the support, and Go Packers!— Jermichael Finley (@JermichaelF88) October 22, 2013
According to a later report by Mortensen, Finley did, indeed, suffer a spinal cord contusion.
It goes without saying that returning to the football field is far less important than his overall health and well-being, something that Mortensen reports the Packers fully recognize:
Finley will seek further medical opinions after he is discharged and a source said his short-term and long-term prospects for playing again will not be hastened with the team's blessing and support, the sources said. One source said Finley's return to the field is "obviously secondary" to his overall health.
Within the report, Mortensen mentions Finley temporarily could not move after the hit.
Speculation suggests he suffered from a brief period of cervical cord neurapraxia (CCN), a condition often characterized by temporary paralysis following neck trauma.
Thankfully, it usually quickly reverses, as it did in this case.
Over the following days and weeks, Finley likely met with a number of different doctors and specialists to monitor resolution of the contusion as well as plan his next steps. He gave his own account of the saga to The Monday Morning Quarterback with Peter King:
My medical treatment to this point has been superb, and the Packers and my agent have been working together to determine how outside medical experts view this injury, how previous cases have been handled and what the next steps of action should be.
As of Nov. 12, it seems those next steps include surgery.
Pro Football Talk's Mike Florio wrote Tuesday that former Packers tight end Mark Chmura told 540 ESPN Milwaukee Finley will undergo an operation this week.
"I got a chance to talk to Jermichael Finley before the game," he said, according to Florio. "...He needs surgery, and it’s herniated in [the C3 and C4 vertebrae]."
As always, exact medical details are not available to the public. However, it seems likely doctors are planning to perform a surgical procedure called a single-level anterior cervical discectomy and fusion (ACDF).
The necessity of an ACDF—and Chmura's quote—suggests the center of one of the cushioning intervertebral discs between two of Finley's vertebrae swelled or broke open.
It may help to think of the intervertebral disc as a jelly donut. The donut represents the outer layer of the disc—called the annulus fibrosus—while its inner jelly represents the soft nucleus pulposus.
When enough pressure builds up—either acutely in the weeks following an injury or over time due to slowly progressing degeneration—the nucleus pulposus can break through the annulus fibrosus and put pressure on spinal nerves as they exit the spinal cord.
Nerve pressure can cause persistent pain, numbess or weakness. The pain can be severe enough to limit an athlete's range of motion, as Chmura noted.
"He literally could not move his neck.”
Fortunately, an ACDF can sometimes solve the problem.
During the operation, surgeons make incisions in the front of the neck and dissect down through soft tissues to the spinal canal. They then visualize the herniated disc, remove it and fuse the vertebrae immediately above and below using metal hardware and bone grafts. By removing the bulging disc, the pressure lets up, and symptoms hopefully improve or resolve.
Chmura stated he is concerned Finley's career is over.
Despite those very legitimate concerns, and while an ACDF is most certainly not trivial, precedent of a successful return to the NFL following the operation already exists. Current Denver Broncos quarterback Peyton Manning recovered and resumed playing at the start of the 2012 season.
Then again, no injury directly translates from one player to another, and every condition is unique. Factors such as the level of the injury within the spine and individual anatomy all come into play.
That said, there still may be reason for optimism.
Dr. Neel Anand, a world-renowned spine specialist and Director of Spinal Trauma at the Cedars-Sinai Spine Center in Los Angeles, California, weighed in on the comparison of Finley to Manning.
"This surgery is no different than what Peyton Manning had," Anand said. "He should make a full recovery and be able to play provided that there are no neurological sequelae." The term "sequelae" refers to a secondary complication of the procedure—possible, but unlikely.
Per a report from @jrehor, Jermichael Finley is going to have a cervical fusion at C3/4. Bit higher than Manning's, but identical surgery.— Will Carroll (@injuryexpert) November 11, 2013
As for the spinal cord contusion, Finley is not alone there, either.
Whether or not Finley follows a similar course will stay unclear for some time yet.
Are you worried about the frequency of injuries like Jermichael Finley's in the NFL?
Unfortunately, what is certain is that his physical rehabilitation will probably be a long one.
Recovering psychologically from such an injury is also no easy task. Finley continued in his column:
Do I have fear? Of course I do. It’s impossible not to have fear given what I’ve gone through over the past four weeks. I’ve worked my entire life to do what I do on that football field, and it’s a very scary feeling being taken off the field on a stretcher.
It will ultimately come down to a successful rehab program and what Finley and his doctors feel is best for him and his family.
Regardless, the positive attitude Finley is showing will serve him well, and considering what could have been, the entire NFL and its fans will surely support him along his road to recovery—whatever route he decides to take.
Dr. Dave Siebert is a resident physician at the University of Washington with experience working in a medical ICU and a level-one trauma center. He has also assisted on multiple ACDF surgeries. Find more of his written work at the Under the Knife blog.