Johnny Knox spinal injury analysis

After Jay Cutler’s thumb injury, Johnny Knox emerged as the go-to wide receiver for Chicago Bears quarterback Caleb Hanie. Blessed with incredible speed, Knox was the primary deep threat in an otherwise anemic Bears passing offense.

This past Sunday against the Seattle Seahawks, Knox sustained a gruesome spinal injury. The hit he took was so horrific that viewers simply hoped he’d be able to walk again.

John O. Watson, MD, is a spine specialist at Memorial Medical Center. After witnessing the Knox injury himself, he knew the receiver’s road to recovery would be a long one. He was kind enough to offer his thoughts on the injury, surgery, and subsequent rehab process.

“In laymen’s terms Johnny Knox sustained a spinal injury (although I have not seen the exact details of the injury). The spine consists of bones called vertebrae, separated by discs (shock absorbers) and connected by ligaments.  When the spine is injured, there may be a fracture, a ligament tear, or nerve damage.  The spinal bones are stacked on top of each other like building blocks. When one of the blocks is out of place or is moving abnormally, this is considered instability.  Instability can cause a worsening spinal injury, and can create tremendous pain if not fixed or stabilized.  

The reason that people have described Knox’s injury as scary is because anytime the spinal cord is involved, permanent neurological injury is possible. The spinal cord will not recover if it is damaged, and an athlete could be rendered a paraplegic or quadriplegic depending on which part of the spinal cord is injured.  In his case, the injury occurred at the lower thoracic or upper lumber region which could have caused paraplegia (which means complete or incomplete injury to the nerves going to the lower body and legs). Most of the reports have stated that his neurological functions below the injury are intact, which is a great prognosis. The other reason that it was unusual and scary was the abnormal spinal bending that was seen on the TV replay. The thoracic spine, which is the middle portion of our spinal column, is not supposed to bend backwards that much and the sight of that can be very difficult to watch. Anytime the spine is seen bending that much, a spinal fracture or ligamentous injury would be suspected. 

The spine is stabilized by ligaments on the front and back, along with joints called facet joints. If there is a fracture or a combination of fracture and ligament tear, the spine may be unstable which needs to be fixed in order to heal properly. Fixing an unstable fracture or ligamentous injury usually involves using screws and/or plates to allow the fracture to heal and prevent any future pain or nerve damage.  If there is a fracture of the facet joint or spinal column, he would most likely need to be in a spinal brace for several weeks or a couple of months after surgery to help assure proper healing.   

In general it is very difficult to give a prognosis unless the exact injury is known, although if his spine is stabilized and there is good bone healing, he could return to athletics in 3-4 months.  It all depends on how many actual parts of his spine were injured. How many fractures, which ligaments, and was there any nerve injury are all questions that would help determine prognosis.  

If Johnny Knox were to return to the NFL, then he would have to be cleared of any restrictions and this all depends on the healing of his injury and any complications that might arise. With most surgeries of this kind, there are many complications that must be discussed including risk of hardware (screws/plates) fracture or loosening, infection, permanent nerve injury, recurrent instability, or adjacent disc herniation.  

As a spine specialist, I treat patients of all ages and see the effects spinal pain can have on someone’s life.  What most people (including Mr. Knox) will not be thinking about is the long term affects of an injury like this when his football days have ended. He could be at risk for early arthritis of the facet joints, or possibly degenerative disc disease that can lead to spinal stenosis and chronic pain. Hopefully he does well, heals up and returns to a productive career in the NFL.”

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