'This gets a lot bigger than just hockey': NHL sets spinal disc replacement precedent in pro sports

Alan Condon -  

In late 2021, Las Vegas Golden Knights center Jack Eichel and Chicago Blackhawks forward Tyler Johnson became the first and second active NHL players to undergo artificial disc replacement. Three months after their surgeries, both players returned to competitive action.

Although these are short-term outcomes, early results in both cases are promising, and the NHL has effectively set a precedent for high-contact professional athletes to be considered for disc replacement, according to Robert Bray Jr., MD, who performed Mr. Johnson's surgery in December.

"Historically when a player injured their neck, the only thing that was allowed was a spinal fusion, and there have been about a dozen fusions performed in active NHL players over the years," Dr. Bray told Becker's Spine Review. "They have a fairly good return, but not all of them returned to play."

Mr. Eichel weighed the pros and cons of spinal fusion versus disc replacement and opted for the latter, a minimally invasive surgery that replaces a degenerated disc in the spinal column with an artificial motion device. Critically, disc replacement allows patients to retain mobility in the spine.

"Artificial discs in the neck have been an ongoing development over the years, with different generations of discs," Dr. Bray said. "They are beginning to replace fusions in many cases because of a number of advantages: They maintain range of motion, they don't put stress on the level above and below, and they have demonstrated excellent biomechanics and outcomes.

"It's my opinion, for a 25-year-old player with a large disc on his spinal cord, performing a disc replacement has the same or less risk than a fusion, less risk long term and a shorter recovery. With a fusion, he'd be out for close to a year before the bone grows solid and he gets through rehab. After undergoing disc replacement, he was back on the ice skating in three or four weeks, working out and taking full contact in practice at eight to 10 weeks and playing in an NHL game three months after surgery."

The route to disc replacement was not easy for Mr. Eichel, who was wrapped up in a monthslong battle with his former team, the Buffalo Sabres. The franchise wanted the 25-year-old to have a spinal fusion instead of a disc replacement, which had never been performed on an active NHL player. The dispute also raised questions about the patient's right to choose their treatment.

It became such a point of contention that the Sabres traded him to the Golden Knights on Nov. 4, according to the Chicago Tribune. Eight days later, he had disc replacement surgery at Rocky Mountain Spine Clinic in Denver. Neurosurgeon Chad Prusmack, MD, performed the procedure.

For that landmark disc replacement to take place, several leading spine surgeons — including Drs. Bray and Prusmack, Frank Cammisa, MD, and Robert Watkins IV, MD — had to collaborate to provide an extensive review of the biomechanics to give the green light for Mr. Eichel's case. 

Pat Brisson, co-head of the hockey division at CAA Sports and the top hockey agent in the world according to Forbes, is responsible for connecting the spine surgeons with the NHL commissioner and the league's union to move the procedure forward. He is also the agent for Mr. Eichel and Mr. Johnson, who both expressed the significant benefit the surgery has had on their lives.

"With the [artificial disc replacement], they say that normally you feel how you were before, but to be honest, I feel better. I haven't been able to sleep on my stomach in probably four years because of this, and now I'm able to do that. I don't wake up in the morning with a stiff neck anymore," Mr. Johnson told nhl.com in March. "Physically, I feel great. I don't have anything that I would consider a setback or limitations or anything like that."

Two surgeries is a small sample size, but the short-term outcomes of disc replacement for both players marks a significant stride forward for sports medicine and patient choice.

"This gets a lot bigger than just hockey. These procedures will be used as hallmark cases. They have set a precedent for high-intensity, contact athletes in pro leagues in the U.S. to be considered for disc replacement," Dr. Bray said. "It's also opening up the realm of a safe, alternative, biomechanically-proven procedure with great outcomes across high-level functioning athletes, and it's putting options on the patient's table that didn't exist before."

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