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Insight on Eichel’s side of neck surgery debate with Sabres

Insight on Eichel's side of neck surgery debate with Sabres

BUFFALO, NY - FEBRUARY 28: Jack Eichel #9 of the Buffalo Sabres prepares for a faceoff against the Philadelphia Flyers during an NHL game on February 28, 2021 at KeyBank Center in Buffalo, New York. The Flyers won, 3-0. (Photo by Bill Wippert/NHLI via Getty Images)

NHLI via Getty Images

[UPDATE: Eichel has been traded to Vegas for a package that includes Alex Tuch and Peyton Krebs.]

Through the 2021 NHL Draft and early free-agent stages, the Sabres haven’t been able to get a Jack Eichel trade done. That doesn’t mean that things have been quiet between Eichel and the Sabres.

At first, Sabres GM Kevyn Adams insisted there was “no rush” on an Eichel trade. That talking point didn’t stick thanks to a surprising statement from Jack Eichel’s agents. Their comments made it clear that there’s still a tense debate between Eichel and the Sabres about what type of neck surgery he should undergo. (At least the Sabres and Eichel agree about a neck surgery being needed. So far?)

That no-rush part is in peril for an interesting reason. Eichel’s agents laid out a scenario where, if Eichel can undergo his preferred form of neck surgery, he might enjoy a swift recovery. Here’s the statement from Eichel’s agents, via Lance Lysowski of the Buffalo News:

Ultimately, though, the Sabres technically have the last say thanks to language in the CBA. So, the impasse remains, and the debate lingers. It’s unclear when there might be a resolution regarding a Jack Eichel trade, or an agreement from the Sabres about his neck surgery.

Amid all of this, most of us have been uncomfortable with a certain thought. What, exactly, is the debate between the Sabres and Eichel regarding this neck surgery choice?

[For more on 2021 NHL Free Agency, check PHT’s tracker.]

Now we have some deeper insight ... at least from Jack Eichel’s perspective. In an absolutely essential interview with Elliotte Friedman and Jeff Marek, Dr. Chad Prusmack laid out the argument, mainly from Eichel’s perspective (and his).

Dr. Prusmack confidently argues for Eichel’s preference: artificial disc replacement surgery. Meanwhile, the Sabres prefer anterior cervical discectomy and fusion (ACDF) surgery. (For the sake of ease and brevity, we’ll stick to “disc replacement” and “fusion” or ACDF in this post.)

If you want more insight into this situation, Prusmack provides it to Friedman and Marek. This post gathers some crucial quotes, claims, and details. Then we’ll wonder what it means for those who might want to make an Eichel trade.

Huge flashing disclaimer: Much like what Friedman and Marek note in that interview, these medical issues are above my pay grade. Consider this a big-picture view, mainly of Eichel’s side.

Eichel’s preference: disc replacement vs. Sabres’ preference: fusion

Here are two very basic explanations for how ACDF/fusion and disc replacement surgery are similar, and how they are broadly different.

  • In both cases, a disc is generally removed from the spine. Replacing that disc is what separates the two procedures. With fusion/ACDF, a surgeon places a graft between vertebrae. Over time, the bones fuse together as they heal. NHL players have undergone this type of neck surgery.
  • Then, you have artificial disc replacement, which Dr. Prusmack notes became available around 2000. In this case, it’s a lot like getting an artifical hip or knee. After the disc is removed, the artificial disc is put in its place.

Importantly, Dr. Prusmack insists that both fusion and disc replacement can be considered “phenomenal procedures.” He’s not totally dismissing the merit of the Sabres’ preferred procedure. That said, he strongly prefers disc replacement surgery, Eichel’s would-be choice.

The case for disc replacement

“If anyone says a fusion is better for someone in the long run, they are not telling the truth, or they don’t know the literature,” Dr. Prusmack told Friedman and Marek around the 27-minute mark.

According to Dr. Prusmack, about 25-percent of people who undergo fusion surgery will need to go under the knife again within 10 years. Meanwhile, Dr. Prusmack puts the rate for disc replacement between 4.5 and 5-percent.

Dr. Prusmack views disc replacement as something closer to “one-and-done,” while fusion carries the risk of “one surgery after another.”

Along with long-term implications, there could be short-term advantages. By Dr. Prusmack’s estimates, a player normally gets evaluated three months after fusion. If that goes well, the timetable to play could be anywhere from 6-9 months.

On the other hand, artificial disc replacement could mean getting back to skating by about six weeks, and possibly engaging in contact within about eight.

[Catch up on NHL trades that have already actually happened.]

There are even possible performance advantages. Dr. Prusmack argues that, with an artifical disc replacement, a player can maintain closer to the normal range of neck motion as before they underwent surgery. With fusion, he compared the addition to something as flexible as “bamboo.”

Dr. Prusmack’s goal: to make Jack Eichel “as close of an indentical twin” as what Eichel was before the surgery. Artifical disc replacement, ideally, would allow Eichel to remain at his elite level. With fusion, it’s possible there will be a disruption of his “neuromechanical coupling.”

That mobility argument has backing. Take, for instance, the Orthopedic Institute of Philadelphia noting “increased spine mobility”

Fascinating stuff. Overall, Dr. Prusmack makes a persuasive argument on “31 Thoughts.”

Limited view of Sabres’ side

At the moment, we know that the Sabres currently favor fusion for Jack Eichel’s neck surgery. There isn’t a ton of insight about the Sabres’ objections to disc replacement surgery.

The little we reportedly know is that:

  • There’s concern that an NHL player hasn’t undergone artifical disc replacement neck surgery yet.
  • Perhaps, that it’s a relatively new procedure, having been introduced around 2000. Meanwhile, fusion is far more established.

Is there more? Maybe the Sabres will shed more light on their preference for ACDF/fusion down the line.

For what it’s worth, Dr. Prusmack claims that disc replacement isn’t “experimental.” It merely hasn’t happened in the NHL yet (he’s claimed to have treated hockey players at other levels, along with athletes in different sports).

“It has a really, really good track record, we just don’t have a track record in the NHL,” Dr Prusmack said.

MMA/rugby comparisons

Dr. Prusmack claims that fusion might make sense for NFL players. NHL players may benefit from disc replacement like athletes who play rugby or engage in MMA. (While football contact can be “blunt, head-to-head,” rugby and MMA often create “whip-like” contact to the head. That might be more akin to what hockey players more generally experience.)

With that, there’s a testimonial from MMA fighter Chris Weidman.

Implications for Eichel trade value?

While there could certainly be more facets to this (especially in favor of fusion), it’s at least useful to get an idea of the sides in the Jack Eichel - Sabres neck surgery debate.

But how should would-be Jack Eichel trade suitors feel about all of this?

On the one hand, a swift recovery could be really nice. That’s especially true if a team traded for Jack Eichel under a win-now edict.

That said, it also underscores the risks involved.

What if disc replacement surgery turns post-surgery Jack Eichel into a weak clone, as if he became hockey’s answer to “Multiplicity?” If fusion ends up being the answer, what if he really does struggle to be anywhere near the player he was?

Eichel’s $10 million cap hit already is risky. It lasts for five more seasons, and a no-movement clause kicks in starting in 2022-23. The Sabres understandably want a big return for Eichel, yet that only makes a trade even scarier.

Especially if you’re a team that’s already uneasy about investing so much in a player who’s experienced so little team success. (I’d argue Eichel doesn’t deserve much blame there, but still.)

Ideally, this works out for everyone involved: Eichel, the Sabres, and whoever might trade for him. Getting that far might not be easy, though.

James O’Brien is a writer for Pro Hockey Talk on NBC Sports. Drop him a line at or follow him on Twitter @cyclelikesedins.