Last October, former Green Bay Packers tight end and current free agent Jermichael Finley suffered a terrifying neck injury when he collided with Cleveland Browns safety Tashaun Gipson. The hit left Finley briefly paralyzed and necessitated his admission to an intensive care unit. Spinal-fusion surgery soon followed.
Over four months later, reports of Finley's possible looming return to the game are beginning to swirl. He made his first free-agency visit to the Seattle Seahawks earlier this month. However, according to Pete Dougherty of the Green Bay Press Gazette, the Seahawks medical staff reportedly failed the tight end on his physical exam.
Jermichael Finley’s first visit is set to be the Seattle #Seahawks, per source.— Ian Rapoport (@RapSheet) March 11, 2014
While news of a "failed" physical following an injury as serious as Finley's certainly raises eyebrows, the failure could imply one of any number of different outcomes. More importantly, not all of them are necessarily poor.
For instance, it is very possible Finley simply still has a long way to go in his rehab. Perhaps he is progressing as expected, but a team like the Seahawks may not want to make a financial commitment until he approaches or completes a full recovery.
On the other hand, an ongoing neurological deficit could prevent some doctors from ever feeling comfortable clearing the tight end to return to the NFL field—as could an unstable spine.
More than likely, the tight end's current status falls somewhere in the middle, and an ultimate determination may remain unclear for some time.
After all, with an injury like Finley's, no amount of caution is too great, and the circumstances of the injury make it clear why that is.
As mentioned, after Finley went down, he experienced a brief episode of paralysis known as "cervical cord neurapraxia"—or CCN. Such a phenomenon is not uncommon following severe head or neck trauma.
Thankfully, his CCN quickly reversed—as is often the case.
That said, doctors later discovered a spinal cord contusion.
In a contusion, a direct blow to the head or neck causes damage to ligaments or other soft tissues around the cord, leading to swelling and cord compression. Cord compression then produces neurological symptoms such as pain, weakness and numbness in one or more areas of the body.
Usually, players must rest until the contusion fully resolves to minimize the risk of serious, potentially catastrophic neurological damage. Often, such a recovery takes several months or more.
In the best-case scenario, a contusion resorbs on its own, leading to no permanent damage. Current New York Giants linebacker Jameel McClain comes to mind as an example of a player who fully recovered from a contusion without major issues—though he needed a full 10 months to do so.
Conversely, other cases—such as Finley's—may require operative intervention.
According to Dr. Neel Anand—clinical professor of surgery and director of spine trauma at Cedars-Sinai Spine Center in Los Angeles—spinal-fusion surgery becomes an option when symptoms linger or radiographic imaging shows evidence of a narrow spinal canal.
"The most common indication would be pain, persistent neurological deficit and imaging findings of persistent stenosis with possible signal changes in the spinal cord," Dr. Anand explained.
In other words, if signs or symptoms of spinal cord compression do not resolve with time, doctors can decompress the area surgically.
The procedure involves removing one of the intervertebral discs—the cushioning discs that lie between the vertebrae—to relieve the pressure within the spinal canal. Then, the surgeon will fuse together the vertebrae immediately above and below the removed disc to enhance spinal stability.
Often, the surgeon then places pieces of the athlete's pelvis bone in the resulting gap to stimulate further bone healing. Once the bones heal together, an athlete can usually return to the field if he or she can regain lost function.
"Once the surgery has healed after a C3-4 fusion, the risks are the same as any player playing at their peak in the NFL," Dr. Anand added.
Then again, Anand also speculated that ongoing symptoms following his operation could be one of the possible explanations for Finley's failed physical.
Hopefully, the tight end's status will continue to improve with time.
He will also likely undergo multiple physical exams and reviews of his imaging studies in the near and distant future.
When do you think Jermichael Finley will return to the NFL?
If his strength returns in full—and if his X-rays do not show spine instability—he may very well make it back to the field sometime in 2014 or 2015. Current Denver Broncos quarterback Peyton Manning—who underwent his own spinal fusion in 2011—missed his entire next season but returned to form in 2012.
Then again, comparing Manning's situation to Finley's represents a bit of an apples-to-oranges situation.
"Manning did not have a spinal-cord contusion, but rather a specific weakness affecting his throwing arm," Dr. Anand went on.
Over the coming weeks and months, the discovery of any increased risk of serious neurological damage—as evidenced by severe spinal stenosis or instability—would complicate Finley's decision-making process significantly.
Whereas one surgeon may decide the medical risk-versus-reward scale tips in one direction, another may hold a different outlook. Even among the best minds practicing the best medicine, expert opinions can differ.
Either way, Dr. Joseph Maroon—one of the best neurological surgeons in the world—gave Finley the best possible shot to revive his career. His final outcome depends on a complex combination of his personal goals and likely multiple future medical evaluations—as well as a team's willingness to take on the risk.
In the end, though, his well-being reigns above all, and the entire NFL community certainly wishes him well as he continues to move forward in his rehabilitation—and to wherever it may take him, either on the field or off.
Dr. Dave Siebert is a resident physician at the University of Washington who plans to pursue fellowship training in Primary Care (non-operative) Sports Medicine. Quotes were obtained firsthand unless otherwise noted.