Before the game on Sunday, Fox Sports’ Jay Glazer reported that, prior to his most recent neck surgery, Peyton Manning flew to Europe for stem-cell therapy. The therapy isn’t yet approved in the United States. For those who are concerned with the controversy associated with the phrase “stem-cell therapy,” Glazer did indicate that Manning did not undergo embryonic stem-cell therapy (which is wrapped in ethical controversy), but rather that they removed fat cells from his (Manning’s) own body and injected them in his neck.
This approach is consistent with a 2007 Medical News Today article that discussed findings by a scientific team at England’s Manchester University that “stem cells from a patient's fat may be used to create new nerves that can repair severed peripheral nerves.” The research was completed in rats, where fat tissue stem cells were “tweaked to become neurons.” The procedure sounds fairly delicate – they
create a replacement nerve, place it in a biodegradable sheath, and attach it to the severed part of the nerve. The result would be that the severed nerve would be joined again.
Two years later, a 2009 Science Daily article indicated that the approach is the “gold standard” for nerve repair. The article goes on to indicate:
transplanted human-derived APCs (adipose precursor cells, i.e., fat cells) survived for up to 12 weeks in the injured peripheral nerve and formed a more robust nerve with nerve cells more than double the size of those formed using the conduit alone.
But a 2009 paper by Sarah Walsh, B.Sc. and Rajiv Midha, M.D., M.Sc., F.R.C.S.C. recommends caution. They indicate that while stem-cell therapy shows promise, it needs to be honed to get consistent results:
Although recent studies have shown that stem cells can act as promising and beneficial adjuncts to nerve repair, considerable optimization of these therapies will be required for their potential to be realized in a clinical setting.
An open question is whether this procedure was done as a last-ditch effort to avoid the third surgery, or as a type of “throw the kitchen sink at it” and hope it works. My sense is that it is the latter – the therapy will not have an instantaneous impact (several of the papers I read spoke in terms of weeks, not hours or days). The timing of the therapy is also relatively inconclusive - they probably chose to do it before Peyton's surgery so he wouldn't have to spend so much time post-surgery on a flight to Europe. At this point, the only thing fans can do is wait and hope that these procedures, coupled with one another, can effect the change doctors are hoping for. It was reported that Manning returned to the Colts' facility on Friday and Saturday, participated in some "light therapy," and even watched a portion of Friday's practice. His return is evidence (if not proof) that his surgery did indeed go well, as reported last week by ESPN. UPDATE: Will Carroll, Sports Illustrated's injury expert, just tweeted some information regarding the timing of Manning's stem cell procedure:
Other key on this stem cell procedure is timing: A) It would have happened in late June, early July. B) If it happened, Colts brass knew.
He also corrected Jay Glazer's assertion that the procedure is not legal in the U.S.:
The type of treatment Manning had *before* his fusion is legal in the US. Several places that do it.
Perhaps his most concerning comment, however was:
Key here -- Manning's alleged treatment didn't work and is now moot. He had the surgery AFTER it didn't help (or help enough.)
If I understand this correctly, it means that there are two possible scenarios. The first scenario is that the stem cell therapy didn't help because at the time, the disc was still impinging on the nerve (and/or scar tissue had developed). The second, less likely, scenario, is that the nerve is simply unable to regenerate, a rare possibility that would have a significant impact on Manning's career.