Doctors chime in on Texans star J.J. Watt's medical outlook

As Texans star defensive end J.J. Watt contemplates his medical options after suffering a setback to his surgically repaired back that underwent a microdiscectomy in late July and has now landed him on injured reserve, doctors weighed in on his medical outlook.

Watt is seeing specialists to determine if he should have another surgery for the herniated disk he aggravated.

Dr. Luga Podesta, the director of sports medicine at St. Charles Orthopedics in New York and a former training camp medical consultant for the Dallas Cowboys and New Orleans Saints, answered the following questions from The Chronicle. Podesta has not treated Watt.

Did he return to the field too soon following his microdiscectomy surgery?

"J.J. Watt underwent spinal surgery for an apparent lumbar disk injury. He underwent a microdiscectomy to remove the fragment of disk material within the spinal canal causing pain in July. Without knowing the extent of his injury or what had previously occurred, it is difficult to know if he has returned too soon. 

"Once a disk is injured, it is essentially injured for life. It is not possible to return the injured disk to normal or replace the disk material that herniated. I would speculate that he possible either re-herniated the same disk or he injured another disks.  J.J. Watt may not have healed enough after his microdiscectomy or had not redeveloped the necessary core strength necessary to protect his recovering lumber spine."

Will he possibly have to undergo a second surgery?

"It is possible that he may require additional surgery depending on the extent of his new injury."

What is the risk of further and more serious injury and how long should he take before returning to the field?

"There is a risk of further injury to the lumbar spine in the future. He will always have an abnormal disk regardless how it is treated. 

"He will be at further risk of lumbar disk degeneration, spinal and-or neuroforemanal stenosis, spinal nerve injury, or early onset of spinal arthritis.

"His return to the field will depend on the extent of the new injury, his previous injury, the treatment performed and how he recovers after treatment. In my opinion, it will take at a minimum three to six months before he can return to football."

Can this potentially end his career?

"Depending on the severity of his injury, this could possibly be career ending."

The following answer was provided by Neel Anand, MD, clinical professor of surgery and director of spine trauma at Cedars-Sinai Spine Center in Los Angeles:

What is a herniated disk and microdiscectomy?

"Herniated disks may be the most common and frequently occurring spine condition that people of all ages seek treatment for. Simply put, a herniated disk (also called a ruptured disk) implies that the protective disk that separates the vertebrae in the spine has slipped, ruptured or bulged out of place. In a healthy spine the disk consists of a ring of fibrous tissue within which is contained a soft gel-like material between each vertebra that cushions the structures of the spine, acts as a shock absorber when we run, jump, or simply walk, and allows for us to move fluidly with no pain.

 "In the case of a herniated disk, the ring of fibrous tissue that surrounds the soft gel-like portion of the disk develops tears and the gel like portion gets squeezed out. This dislodged material in turn places pressure on the surrounding nerves, causing a sharp shooting pain that originates at the site of the herniation, and often radiates throughout the back and sometimes even into the buttocks and legs (this is commonly referred to as sciatica pain).

"There are many different causes for this type of disk herniation, ranging from direct trauma such as a car accident, lifting heavy objects, or chronic conditions such as degenerative disk disease. The symptoms of a herniated disk are common and easy to recognize in most people. Pain that originates at one specific point on the spine (at the site of the disk herniation) and radiates down one or both legs, numbness, tingling, and muscle weakness are indicative of a damaged disk that is pressing on the spinal cord or surrounding nerves.

"So what can be done to treat these herniated disks and relieve the pain? It’s important to know that most herniated disks can be treated with appropriate physical therapy, chiropractic therapy and/or pain relief medications to relieve the inflammation on the nerves. If symptoms are not relieved within one to six months, surgery will then be considered. Though most conservative treatment options do help temporarily relieve the pain, 10 percent of people, including high-performing athletes such as Watt, with a herniated disk will need surgery for a long-term solution.

"One common type of minimally invasive surgical procedure used to treat a herniated disk is called microdiscectomy. During the procedure, the portion of the disk that is impinging on the nerve and/or spinal cord is carefully removed, relieving the pressure and banishing the pain it is causing. The spine and its surrounding tissue are extremely delicate and great detail needs to be observed when performing any surgical procedures in this area. A microscope is utilized during the procedure to magnify the area affected, allowing the surgeon to clearly and precisely view the affected disk and nerves. Operating through a magnified view also allows the surgeon to create a smaller incision, in turn reducing the healing time for the patient post-surgery.

"Generally, no hospital stay is necessary after a microdiscectomy, due to the minimally invasive nature of the procedure, and the patient may return home the same day. Though this type of procedure doesn’t carry as many risks as more invasive operations, it is still important to observe precautions and allow proper time to heal thoroughly and completely before returning to regular activities or before returning to the sports field. Physical therapy is almost always recommended to help the body build back up to its pre-injury level of function, and to ensure a safe and healthy transition back to regular activities as soon as possible."