Sean Richardson reached a crossroads last season when the Green Bay Packers presented the second-year safety with a five-step checklist for resuming his NFL career.
Clear all five hurdles and Richardson would get the green light to return to the field. Fail one and his lifetime of work would be jeopardized.
Richardson doesn't recall the specifics, but the 24-year-old understood the gravity of the situation. Herniated discs aren't good news and his required a single-level cervical fusion of his C5/C6 vertebrae, which was performed by Los Angeles-based Dr. Robert Watkins in January 2013.
The surgery went well, but that was only one step. If there was a chance of a catastrophic re-injury due to excessive nerve damage, Richardson was prepared to hang it up after one NFL season. If scans showed the fusion healed and his nerves recovered, it was back to the practice field.
The process took 10 1/2 months, but team doctor Patrick McKenzie finally gave the go-ahead for his return on Nov. 24 against Minnesota. It just so happens his first in-game snap came on the same special-teams play that ended running back Johnathan Franklin's career.
There's been a hint of mystery behind what plays into the Packers' logic for clearing specific players. So far, Richardson has been the only one among the litany of Packers who have suffered neck injuries in recent years to return.
And it wasn't easy.
"It was very hard, frustrating at times, because I felt great but the MRIs and CAT scans, they didn't look as well as I felt," Richardson said. "I took a lot of time off, just to gather myself and continue to stay positive and work hard in rehab. There were times when I was like, 'Maybe they won't clear me.' But I knew if it was in my hands, God's hands, everything would be all right."
In Ted Thompson's 10 years as general manager, receiver Terrence Murphy, guard Tony Palmer, linebacker Jeremy Thompson, safety Nick Collins and Franklin all have had to call it a career due to significant neck injuries.
Two others — tight end Jermichael Finley and defensive lineman Johnny Jolly — remain unsigned after undergoing C3/C4 and C5/C6 cervical fusions, respectively. They've both been cleared by their surgeons and still want to play.
Standing near his locker, Richardson counts himself lucky. His patience was tested, but he ultimately was able to get back to doing what he loves. He played in six games last season and finished with 13 tackles.
"I don't know how they feel, but after I had the surgery, right after the surgery, I felt normal," Richardson said. "Some people say they lose strength in their limbs and their arms and stuff. I never lost any strength or anything."
Brain is the power station
There are seven cervical vertebrae, each separated by soft tissue referred to as discs. When a herniation occurs, the disc bulges and makes contact with the spinal column, which can cause numbness and paralysis depending on the impact and location.
The single-level fusion happens when the disc is removed and replaced by a bone graft (often taken from the hip) and inserted between the vertebrae. The reason surgeons take the graft from the hip or pelvic bone is because the bone marrow available in the Iliac crest allows the two discs to fuse while a titanium plate is screwed into the vertebrae to stabilize it.
Richardson felt like himself again because the herniated disc in his neck no longer was putting pressure on his spinal column. He was able to return because the Packers felt comfortable with how the fusion and nerves healed. If performed properly, experts agree the chances of a re-injury following a fusion are minimal. A return to the field depends on the nerves regenerating.
Dr. Neel Anand, orthopedic spine surgeon and director of spine trauma at Cedars-Sinai Spine Center in Los Angeles, has followed the NFL condition for years. In his opinion, neck injuries like what the Packers and other teams have been suffering aren't new.
So what's the difference between Finley and Collins' injuries at the C3/C4 level compared to the herniation that Jolly and Richardson sustained at C5/C6? Anand relates it to the brain as a power station — the closer you get to the source, the more caution is required.
"C3/4 is higher up on the spinal cord for it involves almost all the nerves going to your hand. The nerves come off the spinal cord and down to your hand and the rest of your body to your legs," Anand said. "C5, for example, is a deltoid (muscle), so if you have a C5/6 injury your deltoid is usually working. If you have a C3/4 injury, nothing is working. That's the difference. It's anatomically where the injury is and what nerves are involved. It's like a brain injury is worse than a C3/4 or a C5/6.
"As you go higher up, do you knock the power station out or do you knock the cable coming off the power station? The further the cable is away from the power station, the more people are in a better position."
Some conditions — like stenosis (narrowing of the spine) — can't be remedied by surgery. In fact, Franklin, hasn't undergone surgery, even though it's likely his career is over.
Another condition is similar to a spinal-cord concussion. That happens when the spinal cord takes a hit and whiplashes into the spinal canal, but leaves nothing to decompress. Anand likens it to a concussion that must recover on its own over time just like the brain. It's unclear which type of injury Franklin sustained.
Each case is different
Richardson didn't know anything was wrong after he suffered the injury on a special-teams play against the New York Giants on Nov. 25, 2012, because it was his back, not his neck, that tightened up.
He wasn't carted off the field like Collins or Finley, who both sustained temporarily paralysis. He even reported to practice before finally getting to the core of the problem. The same was true for Jolly, who battled stingers before being placed on injured reserve in December.
Although Richardson wasn't able to run during his initial rehab, the Packers saw progress in his recovery. Where they released Collins and Franklin following their injuries, the Packers held onto Richardson before finally activating him in November.
By the end of the year, Richardson and fellow undrafted safety Chris Banjo had developed into reliable special-teams contributors and rotational defensive backs despite not being able to participate in the offseason program.
"Chris was kind of thrown into the fire, but Sean's situation was even tougher because he couldn't take any practice reps or anything," Packers safeties coach Darren Perry said. "Those guys should be light years ahead of where they were last year. We'll see how far they continue to grow."
Richardson said he's no longer thinking about it, though defensive backs and special-teams players can be more susceptible to neck injuries because of the collisions they encounter.
Packers coach Mike McCarthy has been adamant this offseason that Finley's injury isn't as severe as Collins' was in 2011, but there's only a small circle that knows what the scans look like. Ultimately, it'll be up to the Packers and McKenzie to decide how the organization proceeds.
Their track record is conservative, but in Richardson's case, he passed the test. Only time will tell if Finley and/or Jolly will follow.
"The usual reason for somebody not coming back is neurologically he's not at that top level because his nerves took a bang and fusion doesn't make the neurology better," Anand said. "Fusion stabilizes the spine. Injury has already happened. Time makes the injury better. Just because you fuse somebody's spine, it doesn't make his nerves better.
"We take anything that's there away from the spinal cord and stabilize the spine so it's not getting any more traumatized and allowing the nerve to recover. That's what the surgery is all about. If that nerve recovers, that guy is completely normal and can go back to doing whatever he wants. If it doesn't recover, he can't."
— whodkiew@pressgazette media.com and follow him on Twitter @WesHod.