Adam Schefter broke the news this afternoon that Tony Romo's back injury is much worse than initially believed.
Cowboys QB Tony Romo has been ruled out the rest of the season due to his back injury, per league source.— Adam Schefter (@AdamSchefter) December 23, 2013
Shortly after Schefter's report, both Jay Glazer and Chris Mortenson tweeted that Romo's MRI showed a herniated disc. Jason Garrett told the media during his afternoon press conference that the Cowboys' had not yet ruled Romo out this week and were hopefully that he'd recover with treatment this week.
The consensus from all the heavy media hitters is that a return is very unlikely. And there's no reason for Garrett to tip his hand at quarterback on Monday. He has every reason to bluff until very late in the week, assuming Romo doesn't have surgery before then. It's possible that a combination of rest, anti-inflammatory medications and, possibly, an epidural injection could get Romo functional enough to play this week. But there's very little optimism in the reports thus far.
After speaking with a neurosurgeon this afternoon about Romo's symptoms, I think there's more to this story.
The rapid and unexpected escalation from Romo's post game optimism yesterday to Schefter's bombshell this afternoon brought Romo's April "cyst removal" immediately to mind. Romo and the Cowboys minimized the procedure this offseason and there are lots of superficial conditions that might fall under the category of cyst removal. However, Romo wasn't cleared to practice for three months after his surgery, suggesting the procedure was more than superficial.
I believe Romo confirmed that his offseason surgery was spine related in the locker room after yesterday's game, saying that his symptoms were in "a completely different spot than the back stuff I had last year." I think it's possible that Romo had a juxtafacet cyst removed in April.
Though sometimes asymptomatic, such cysts can sometimes put pressure on nerve roots and cause symptoms similar to that of a herniated disc. Removing those cysts commonly involves removing part of the vertebrae, which in turn raises the risk of more degenerative changes and disc herniation in the area.
Romo said last night that his symptoms were in a different spot, but that doesn't necessarily mean the source of the symptoms is in a different spot. Symptoms related to nerve root impingement can occur at any point along the length of the nerve -- from the lower back to the hip or anywhere that particular nerve travels in the lower leg.
Understand that I'm speculating here, but if Romo had a facet cyst removed and his current symptoms are due to a disc herniation at the same level, there's a high likelihood that Romo will need another surgery to relieve the pressure on the nerve roots in the area. And that procedure may well include a spinal fusion.
If this is what Romo is dealing with, it's highly unlikely that he'll recover in time to play this season. Surgery for such a condition would not definitely end Romo's career, but it would necessitate 3-4+ months of rehab.
It's possible that Romo's new disc herniation is entirely unrelated to his April procedure. But the outlook isn't a whole lot rosier if that's the case. If Romo needs surgery to treat a herniated disc, that would likely be two surgeries to his spine within nine months. (Again, I'm assuming that Romo's April surgery was spine related.) Both surgeries would be to treat degenerative issues in his back. Players suffering from degenerative changes at one level are at higher risk of future complications. Surgery to two different levels would further increase his risk of future complications.
Again, there's a fair amount of ifs and speculation in this post, but the pieces fit together. We'll know more as the week progresses.
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