Analysis of Bills safety Micah Hyde’s neck injury

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The Buffalo Bills received disappointing news this past Saturday as All-Pro safety Micah Hyde went to IR with a cervical disc herniation.

This came on a relatively benign hit trying to tackle Tennessee Titans wide receiver Robert Woods late in the third quarter as seen below.

#Bills Micah Hyde neck injury.

He did not return to the game & was later evaluated at the hospital.

Possibility of a stinger based on how he hit face first & injury designation.

Good chance he could play Sunday if it’s a stinger, will have to watch practice reports. pic.twitter.com/8IppDI1OqI
— Banged Up Bills (@BangedUpBills) September 20, 2022

Following the hit, Hyde walked off the field with the training staff, going into the blue medical tent for an assessment. He later used the cart to get from the sidelines to the locker room before reportedly going to the hospital later for further evaluation.

With hindsight now available, he went to the hospital as he likely had some degree of paraesthesia—which is numbness and tingling down the nerve that is compressed in the neck. Imaging was warranted as part of the Canadian C-Spine rules with likely paraesthesia necessitating further evaluation.

Hyde missed practice Wednesday and Thursday, which was followed by a report that he sought a second opinion out of town, per The Buffalo News. While a second opinion is not always a bad thing, TJ Watt of the Pittsburgh Steelers recently dealt with this for his pectoral injury and elected to forgo surgery.

Sometimes there are doctors who are more specialized that are worth going to see to determine whether there are alternative interventions or if their professional opinion differs.

Regrettably, the opinions were likely similar, resulting in the decision for Hyde to be placed on injured reserve, ending his season per his agent's words.

Unfortunately client Micah Hyde will be put on IR today due to his recent neck injury. Fortunately, we expect a healthy return for #23 in 2023 #BillsMafia #NFL
— Jack Bechta (@jackbechta) September 24, 2022

Below is a detailed discussion regarding the anatomy, procedure, and outcomes as Micah Hyde looks to return to football.

Anatomy

The neck is made up of seven cervical vertebrae that allow the spinal cord to pass through the middle, acting as a protective framework. This also creates the support necessary to support and maintain the head in an upright position.

In between these vertebrae are intervertebral discs that help provide space for the nerves branching off the spinal cord to innervate their respective areas of the body. The discs also allow for the movement of the vertebrae over each other. This provides stability around the spinal cord and nerves but also allows for mobility for all neck movements.

A disc herniation occurs when there is either a traumatic event such as an unexpected blow to the head/neck area or degeneration to the area over time. In the case of Hyde, the facemask hitting the receiver's body, snapping his head backward likely herniated the disc. Hyde has had a history of at least four neck injuries dating back to at least 2015. However, it isn’t public knowledge whether he had any pre-existing issues that led to this latest injury.

Sometimes all it takes is one hit to herniate the disc.

When a disc herniation occurs, the tough outer annulus fibrosus tears, allowing the nucleus pulposus to push out through the tear, which in turn, pushes on the spinal nerve that branches off the spinal cord. That pressure on the nerve can send pain down that nerve pathway, usually into the arm, and cause what is known as radiculopathy or paraesthesia.

This can be felt as pain, numbness, tingling, and weakness—leading to difficulty with everyday activities. This disc protruding may also limit neck motion or cause significant pain. Through physical testing, doctors can narrow down what level is affected based on the symptom presentation and use imaging to confirm the diagnosis.

Hyde will likely undergo an anterior cervical discectomy with fusion (ACDF) in the coming days or weeks. The ACDF is considered the gold standard when treating cervical disc issues that have not been resolved by conservative means.

Surgery procedure

The anterior cervical discectomy with fusion is a procedure in which a surgeon enters the neck anteriorly, near the throat, to remove the herniated disc and fuse the vertebrae that were above and below where the disc was removed. The surgeon fuses this together using a piece of extracted hip bone to create a bony spacer where the disc was prior. The surgeon then places a plate over the front that connects the two vertebrae together to create the fusion.

This reduces the pressure on the cervical nerves, leading to long-term stability. These outcomes are overall very positive with 80% of players across all sports that have this procedure returning to play with no discernible change in the quality of play.

Within football specifically, that number drops to 70%. There is also a chance for adjacent segment degeneration 10% of the time. This means that the level above and below the surgical area begins to have problems.

Most return to play within nine months, though this was between a variety of professional sports. General rehab protocols allow return to sport at six-plus months, but that timeline could vary based on the doctor and recovery process.

Failure rates for ACDF vary anywhere from 2.1% to 9.13% for a single level in the general population, which is rather low. For athletes specifically, it is reported at 5.8%. In addition, a return to contact sports for a single-level fusion is acceptable with no long-term concerns. If there are multi-level fusions, those are generally contraindicated for further contact sports.

Looking at the research, Hyde likely suffered a disc herniation to his lower cervical vertebrae between the C5-C6 and C6-C7 vertebrae. These are the most common areas for disc herniation, though all other levels could be in play. Below are the symptoms based on nerve root level involvement.

C5 - C6 (C6 nerve root): May cause weakness in the biceps and wrist extensor muscles. Numbness and tingling along with pain can sometimes extend to the thumb side of the hand. This is one of the most common levels for cervical disc herniation to occur.
C6 - C7 (C7 nerve root): May cause weakness in the triceps (muscles on the back of the upper arm) and the finger extensor muscles. Tingling and numbness, and pain may radiate down the triceps and into the middle finger.)
C7 - T1 (C8 nerve root): May cause weakness in the hand’s ability to grip. Numbness and tingling and pain may radiate down the arm to the little finger side.

However, upper-level cervical disc herniations (C2-C3, C3-C4) are more common in NFL players due to the collisions within the sport. But there are risks with performing procedures in the area that are high up as mentioned later in the article.

But the confidence that Hyde’s agent exhibited suggests that it’s a lower cervical disc issue where there is more leeway if degeneration occurs at another level.

Considering the immediate need to perform surgery, it suggests that this is a disc herniation that doctors have found will not resolve with rehab or conservative measures.

There were other options including a cervical foraminotomy. A foraminotomy is where they shave some of the bone surrounding the nerve to create more space and reduce compression. While a foraminotomy has a quicker return-to-play timeline, returning 92% of the time—it has a reoperation rate of 50%.

Comparable Buffalo sports neck injuries

Plenty of players have successfully returned following a single-level ACDF including quarterback Peyton Manning and wide receiver DK Metcalf, among many others. Former LSU and now Dallas Cowboys linebacker Damone Clark underwent this procedure shortly after the 2022 NFL Draft. This surgery is not a career ender by any means.

Bills fans are undoubtedly worried about Hyde’s future considering what the fan base went through with safety Aaron Williams, center Eric Wood, and those who root for the Buffalo Sabres, center Jack Eichel. Each situation was vastly different.

Williams initially suffered a significant stinger tackling New England Patriots wide receiver Julian Edelman in Week 2 of the 2015 season. He was placed on IR for the remainder of the season and underwent a foraminotomy back in 2015.

During practice prior to their first preseason game, he then suffered a collision with wide receiver Dezmin Lewis that gave him a concussion. He sat out a few weeks but was able to return to play in Week 1. Unfortunately, Williams suffered the crackback block courtesy of wide receiver Jarvis Landry, ending his season. Due to the culmination of the neck and head injuries, teams were leery of signing him, thus ending his career.

Eric Wood had a bulging disc at C2-C3 that caused repeated stingers throughout the season before an end-of-season exit physical caught the issue. Considering how high up it was, it was best to retire due to the vital nature of the area.

That portion of the cervical nerve roots controls the vagus nerve, which controls a number of bodily functions including the diaphragm—responsible for breathing. Losing function below that area would be devastating and life-threatening if things had worsened. This is why I believe that Hyde doesn’t have a disc herniation up that high the way they spoke.

Finally, Jack Eichel was an excellent candidate for the ACDF, but his issue was that he wanted the artificial disc replacement, which he ultimately received. The Bills and Sabres share the same group of doctors and if Hyde wanted to go down the artificial disc replacement route, he will quickly hit a dead end. You can return to play football with a single-level fusion; the ADR hasn’t been tested in football yet.

Return To Play & Career Outlook

There is a small chance that Micah Hyde could return late in the season after four months, possibly for the playoffs based on rehab timelines. However, this is a really aggressive timeline and we have seen the Bills exercise caution following surgeries, most recently with cornerback Tre’Davious White’s ACL rehab. We even saw it with offensive tackle Spencer Brown this summer with his discectomy, waiting three months to ramp up to play.

I’m not saying it isn’t possible, but we would need a lot of positive developments and the team would have to exhibit a huge need for him to come back. He would need to have full healing of the surgical site, have no pain during regular activities and abolishment of pain down the arm, and be cleared for contact.

If he can return this season, great! But I’m not expecting that he does so until the 2023 season.

Once Hyde does return, on average, players play for 3.1 more years with no discernable drop-off in performance. The article cited does highlight upper cervical surgical procedures including fusion, which can’t be ruled out in Hyde’s case. But I suspect the narrative would have been different regarding the outlook.

Whether Hyde plays for another three years or not, there are other factors in play depending on how much longer his career goes on including his health, contract, quality, and willingness to play, among other things.

It’s incredible to think that the hit that cornerback Dane Jackson received that same night leads to him continuing his season while the hit that Hyde sustained ended his season. This is the reality of football; things change in an instant and every injury is unique.

I sincerely wish Micah Hyde a full recovery and a return to play in 2023.

Anatomy

Surgery procedure

Comparable Buffalo sports neck injuries

Return To Play & Career Outlook

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