Vander Esch diagnosed with spinal stenosis: On the condition and treatment

Dallas Cowboys

Dallas Cowboys’ star Leighton Vander Esch was recently diagnosed with spinal stenosis and will miss the remainder of the 2019-20 season. The linebacker is expected to be back for next season.

Dallas Cowboys linebacker Leighton Vander Esch will miss the remainder of the 2019-20 season after undergoing a minimally invasive procedure to address cervical spinal stenosis, reports Clarence E. Hill, Jr. of the Fort Worth Star-Telegram. Hill also outlines that Vander Esch missed Dallas’ previous five games after being diagnosed with a disc herniation in his neck.

This is undoubtedly disappointing news at the end of a disappointing season for the Cowboys and their fans alike. Esch, who was a three-year standout at Boise State, earned Pro Bowl and Second Team All-Pro honors during his 2017 rookie campaign, but injuries limited his impact during his sophomore season.

Spinal stenosis with a concomitant disc herniation is a significant injury, but the Cowboys are hopeful that Vander Esch’s career won’t be significantly impacted according to Hill’s reporting.

Spinal stenosis can occur at any level — cervical, thoracic, and/or lumbar — of the vertebral column and comes in two main flavors: central and foraminal. Spinal stenosis can be acquired due to injury, but it is possible that athletes can be born with a genetic predisposition to the development of the condition, which is known as congenital stenosis. Based on the sourced reporting linked above, it would seem as though Vander Esch’s spinal stenosis is of the congenital variety.

Central stenosis occurs when the circumference of the central canal — the area where the spinal cord is located — is narrowed; this can be due to intervertebral disc herniation and/or boney build up, such as a bone spur. With central stenosis, the actual spinal cord is impinged upon, which can lead to certain characteristic symptoms, such as pain when the spine is extended (i.e. tilted backwards) as well as numbness, tingling and weakness in both arms or legs.

Central stenosis can be treated surgically in two different ways. The first occurs if the stenosis is being caused by a disc herniation and is known as a microdiscectomy. With this procedure, the portion of the intervertebral disc that is impinging on the spinal cord is excised, which reduces the pressure being placed on the cord. The other procedure is known as a laminectomy and involves removing the portion of the vertebra known as the lamina, which results in a widening of the central canal. This also reduces the amount of pressure being placed on the spinal cord.

Foraminal stenosis differs in a few key ways. Instead of the spinal cord being compressed, in foraminal stenosis the nerve is pinched as it exits the vertebral column — this area is called the foramina. This can be caused by disc herniations, bone spurs and/or loss of intervertebral disc height. Spinal extension also causes pain in foraminal stenosis, but the extremity symptoms are usually single-sided.

Foraminal stenosis can be address surgically with a minimally invasive procedure. The term “minimally invasive” simply means that the entry incision is small and doesn’t require the incision to remain “open” for the entirety of the procedure. With this surgery — known as a foraminotomy — the extra bone is removed, which opens up more space for the nerve to operate; this usually reduces pain as well as any residual numbness or weakness. Foraminal stenosis can also be treated with a microdiscectomy if a disc herniation is the culprit.

If any of the above mentioned surgical interventions are unsuccessful, a spinal fusion may be an appropriate next step. A study published in the Journal of Neurosurgery in 2016 reported that the return to play rate after cervical spinal fusion was between 50-87 percent.

The fear surrounding playing a sport as physical as football with a diagnosis of spinal stenosis revolves around the idea that the athlete may be at an increased risk for spinal cord injury. This thought is debated, with the research being largely inconclusive at this time. However, an article published by the American Academy of Orthopedic Surgeons in 2016 recommended that athletes participating in contact sports retire from competition if they experience recurrent bouts of neurological deficits and symptoms, particularly after surgery.

The recovery timeline after minimally invasive cervical spine surgery is usually at least six weeks, meaning Vander Esch, barring any significant setbacks, will likely be cleared to return to play much before the start of the 2020-21 NFL season. However, this injury will be something the Cowboys will monitor closely for the remainder of his career.

Vander Esch has accumulated 212 combined tackles and two interceptions over his first 25 NFL games and figures to be a key member of the Dallas defense for the foreseeable future.

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