Michael Porter Jr.’s back injury, explained by a surgeon and a jelly doughnut

Michael Porter Jr., one of the nation’s best NBA prospects, suffered a back injury in the opening two minutes of his college basketball season that cost him all but two games, and required surgery he hasn't yet fully recovered from. Less than a week before the draft, he even canceled a workout in front of lottery teams because of muscle spasms so bad he couldn‘t leave bed, before deeming it back on.

In the hours before the draft, ESPN’s Jonathan Givony reported that Porter was sliding due to concerns about his back and hip. Sure enough, Porter nearly slid all the way out of the lottery, despite being in contention to go No. 2 overall. The Denver Nuggets finally took him with the No. 14 pick.

What’s wrong with the spine of one of the NBA’s most promising teens? And is it bad enough that he should have slid this far?

In November, Porter had a minimally invasive back surgery called an L3-L4 microdiscectomy to treat herniated disks in his back. The discomfort was caused by small tears in the outer layers of the intervertebral disks that allowed important lubricating material to leak out. Yahoo’s Shams Charania reported that he had a second surgery of his lumbar spine in mid-July.

“One analogy we use a lot is when you poke a hole a jelly doughnut,” Dr. Charla Fischer, a spine surgeon at NYU Langone Health, told SB Nation. “When you squeeze the jelly is gonna come out. If you don’t poke a hole, it’s going to be contained.”

Porter’s talent may have his injury in the spotlight, but herniated disks are not that unusual.

“That process of those small tears happens to everyone over time,“ Fischer says. “Genetics plays a small role, but over time everyone’s disks deflate like a tire getting worn down. In some athletes, if stress is being transferred to an area ... it’s a repetitive stress injury. Over and over, jumping up to catch rebounds, you’re getting stress in one area. Then you get these micro tears and the nucleus pulposus (jelly) comes out.“

Can the prospect once thought to have a higher ceiling than expected top picks Deandre Ayton and Luka Doncic return to form? Will his back hold up over time, or is he destined to have career-long issues? When will Porter look better than he did at Mizzou?

Those questions still lie ahead of the 19-year-old, especially now that he’s slid in the draft.

Why did this happen to Porter?

Pinning down exactly what happened to Porter is difficult. He could be more susceptible to herniations because of his genetics, or maybe there was specific stress in that region of his back that started tears which caused the liquid to leak.

That could mean the specific motions of catching and coming down with rebounds, or possibly over-rotating his spine on passes. But the injury also could have been caused by life itself.

Fischer sees patients like you or I in for the same procedure Porter had. This injury isn’t reserved for athletes.

How’d Porter need surgery all of a sudden?

There wasn’t a single specific event that caused Porter’s injury to happen. It built up over time.

“Usually [patients] have this back pain that’s not severe, but there’s sort of a dull ache for a while,“ Fischer says. “And then it gets worse and worse and worse as those micro tears build up and then the [jelly] makes it’s way out, and that’s painful.

“Then it herniates into the canal and all of a sudden the back pain isn’t that bad and you have severe leg pain or numbness or tingling or weakness in the leg.”

That’s what was likely happening when Porter checked out of his first Mizzou game with a “tweaked hip.”

Porter Jr.’s surgery wasn’t as terrifying as it’s made out to be

There’s a stigma around back injuries in athletes, and while it’s an extremely dangerous part of the body to hurt, Porter’s surgery was minimally invasive.

“This is an outpatient surgery,” Fischer says, ”like if someone had a knee scope. So you’re only in the hospital for the day of the surgery and then you go home.”

Microdiscectomy surgeries typically last an hour, and patients leave the hospital the same day they walk in. Fischer says patients can walk around, eat, and use the bathroom immediately after waking up.

Porter wasn’t bed-ridden.

How was Porter‘s surgery performed?

“We make a small incision in the back,” Fischer says, ”and we have to get to the disk herniation so we have to go through some muscle of the back ... we have to go through some bone. So a small amount of bone we need to make a hole in in the back part of the spine. Then we protect all of the nerve roots, we get down to where the herniation is, remove all the material and that’s it.

“We’re only taking the part that has come out, we’re not going into the disk and taking everything out. Only the jelly that’s squirted out of the doughnut we take. We leave the rest of the jelly in.

“This is one of the least extensive surgeries you can have in the spine, it’s just still a spine surgery.”

How do patients typically feel after this surgery?

Better! Way better almost instantly.

“Most patients tell me they feel at least 50 to 80 percent better immediately after the surgery,“ Fischer says. “That’s because the jelly that comes out of the doughnut causes a huge inflammatory response in the area. It’s not just pushing on the nerve root, but it’s causing all these inflammatory factors to come in the area and cause an almost internal bruise. Once you remove that, all those factors go away and you feel a lot better.“

So why did Porter look so bad when he returned at Mizzou?

There have been enough lumbar spine injuries in the NBA for a team of doctors to conduct a specific report on it. This Sports Health study by Shobhit V. Minhas, MD, Benjamin S. Kester, MD, and Wellington K. Hsu, MD, takes a look at the recovery times for NBA players who’ve had the same type of surgery as Porter.

Using PER as a baseline, the study found that a patient won’t return to his typical level of play until his second season following surgery.

Porter returned to play four months after surgery, which Fischer said sounded about right for someone of his age and athletic abilities. But even if he’s fit enough to play, history says he’s still not going to be delivering peak performance immediately. It probably won’t be until his second NBA season that we see Porter at full strength.

But Porter nearly canceled workouts with back spasms that kept him in bed. Isn’t that bad?

“It sounds normal,“ Fischer says. “It seems like he had some leg muscle weakness from the disc herniation and has had to work on building strength back.“

Whichever team drafts Porter will have to stay patient.

What are his chances for re-injury?

This is the dangerous part in drafting Porter. He will heal from back surgery, and history says he should bounce back to full strength in two years, but he’s at risk for the same injury. NBA teams were sufficiently worried.

"The area where the jelly has come through the doughnut ... that heals over, but not with the same material you were born with,” Fischer explains. ”It fills in with fibrous tissue and scar tissue and it’s similar but not exactly the same. So that area is an area of weakness.

“There’s re-herniation rates of 10-to-12 percent over the next 5-to-10 years. I tell patients that all the time because I want them to know that if the symptoms come back we can start from square one ... Elite athletes need to get back to playing sports. If he had that again, he’d elect to do another surgery.”

Photo by Jamie Squire/Getty Images

Would a second surgery spell doom for Porter’s career?

Nope. It would not.

“It doesn’t affect his return to play,” Fischer says. ”It doesn’t affect his physical therapy, it doesn’t affect his chance of neurologic problems like weakness or numbness or tingling. Some patients say it hurts a little more because we’re going through scar tissue and that’s about it.“

So how worried should you be if your team drafts Michael Porter Jr.?

"These teams have an in-house spine surgeon or will have him evaluated by someone. He’ll be extensively evaluated before anyone decides if they want to draft him. He’s gone through the ringer, if he’s been picked that means he’s been picked by multiple spine surgeons and they agree his recurrence risk is low.”

Of course, that’s Fischer’s professional opinion, so please adjust that logic based on your team’s level of medical dysfunction.

“Whether or not he’s a higher risk, it’s hard to say. Other than being a weightlifter or bodybuilder or smoking, all these athletes are in peak shape. Out of someone who’s going to be a recurrent risk, he’s not doing anything that’s going to put him in a bad spot.

“Even if he didn’t look so good at the end of his current season, he could do well next year. He can definitely bounce back, and there’s enough NBA players who have this for there to have been a study just on NBA players with disk herniations. It’s not so rare that’s there’s only case reports in the literature. There’s a full study looking at 61 NBA players. It’s not a totally rare unheard of thing for NBA players to have microdiscectomies.“

Nobody wanted to be feared out of passing on a player with star potential, yet that appears to have been the case with Porter.