What is the long-term prognosis for David Wright's career with the Mets?
While Wright spoke somewhat optimistically about returning this season when he met with reporters Friday in Los Angeles, the Mets appear to be more cautious than optimistic. General manager Sandy Alderson said, "There hasn't been any significant change in his routine'' in treating lumbar spinal stenosis, a narrowing of the spinal canal in the lower back.
That effectively doused Terry Collins' midweek interpretation of a conversation with Wright that suggested that a resumption of baseball activities was on the horizon.
Starting with a stress fracture in his back in 2011, Wright, 32, has played only one full season in the last five. He has played in only eight games this season and has been on the disabled list since April 15. Two of his stints on the DL were attributed to issues with his right hamstring, which some specialists believe could have been related to the earlier stress fracture and ensuing diagnosis of spinal stenosis.
Wright is under the care of Dr. Robert Watkins, an orthopedic spine surgeon in Marina del Rey, California. Wright, according to Alderson, has received anti-inflammatory epidural injections in addition to physical therapy.
Watkins is something of a surgeon to the stars, having operated on Peyton Manning's neck and Dwight Howard's back and cared for Wayne Gretzky, Don Mattingly, Troy Aikman and Joe Montana.
Said Alderson: "Surgery is a possibility, but I think surgery is something that needs to be avoided at all costs. I think that going this route is the most prudent, it's the most likely to be successful. We just have to be patient with it, that's all."
Are the odds of a comeback lower with surgery?
"I can't tell you that,'' Alderson said. "I haven't actually had that conversation with the doctor, haven't gotten into that detail. But I do know surgery is not the preferred approach in this case. We want to avoid it.
"It's not a matter of well, let's see if we can rehab the elbow and if not, we'll do the [Tommy John surgery] because it's a matter of time, you lose more time. I think there is a qualitative issue about what happens after surgery. But again, I haven't gotten into that detail with doctors."
Wright said of possible surgery: "I guess if this doesn't work. But I'm focused on this working, I'm optimistic that it's gonna work. There is a procedure for it, but it's more for older people. I'm not sure it's typically meant for people that have to bend over, rotate, have torque for a living. I know there's a surgery for it, I was made aware that there's a surgery for it, but it hasn't been recommended."
What are Wright's thoughts on potential surgery?
"I have very little knowledge of it,'' he said. "I sat down for the consultation with the doctors, the first couple of meetings. I was made aware that there is a surgery for it. I was also made aware that Dr. Watkins was going to do everything in his power to make sure that I do not need that surgery, and that's really the only time we've talked about it. He made me aware there is a procedure and he also made me aware that it's normally for people a lot older than me and don't necessarily have to twist and turn and move up and down. That was the only time we ever even discussed it, and it really wasn't even a discussion. He just told me he was going to do everything he can to keep me from having it. It wasn't recommended then and it definitely hasn't been something we've discussed since."
Spinal stenosis surgery for baseball players sounded alarms after former Met Lenny Dykstra, then with the Phillies, failed to play again after a procedure in July 1996. He was placed on the voluntarily retired list by the Phillies in November 1998. But the Philadelphia neurosurgeon who performed the procedure, Frederick Simeone, said the operation was a success.
"On his two post-op visits, he was doing very well. He had no problems,'' Simeone said Saturday. "He had been back to exercising. As far as I was concerned, the operation was successful.
"My opinion always was that his failure to return to play was not the result of any back problem. When I saw him on his post-op visits, he was fit for duty. The operation was a simple operation, one that I'd done thousands of times. This was no different from any other.
"He was seen twice in post-operative care, offered no complaints and was doing very well. If he developed any problems after the surgery, he never reported them to me. In my mind, he was an easy diagnosis, easy surgery and a good result.''
Dykstra could not be reached for comment.
If Wright's ailment prevents his return or continues to recur because of the rigors of playing third base and batting, what options remain beyond the conservative treatment he has received?
No doctor treating Wright has spoken about his condition, and other doctors who have commented in general terms have not examined Wright.
"If you've exhausted a fair amount of conservative treatments, a few months like he has, I would already be considering it now depending on what type of stenosis and what type of progress they've made,'' said orthopedic surgeon Stefan Prada of Laser Spine Institute in Tampa, Florida.
Prada said a minimally invasive procedure "would definitely get him back for spring ball next year.''
It is unclear if Wright's stenosis is congenital or occurred because of an injury. He never reported any back issues until 2011, when he suffered a stress fracture in April of that season by diving to tag out the Astros' Carlos Lee.
"Typical treatment for congenital stenosis is just a laminectomy,'' said orthopedic spine surgeon Thomas Dowling of Long Island Spine Specialists in Commack, who described that procedure as "the unroofing of the spine like the old-fashioned dollhouses. You just take the roof off and see inside.
"If the spinal canal is too narrow, you can enlarge the spinal canal by creating a skylight. There are other minimally invasive techniques to where they can actually go in and selectively create little smaller skylights with a nerve root exit.''
Wright's current disabling started with what the Mets termed a strained right hamstring. He had a similar diagnosis in 2013 and was lost for seven weeks.
"These episodes of hamstring problems may be coming from the spinal stenosis,'' said Dr. Joseph Congeni, director of sports medicine at Akron Children's Hospital. "So what happens, as he's narrowed in that area, there's compression on the nerves that innervate the hamstring and David says, 'I've got hamstring pain, tightness and soreness.'
"I don't know, I haven't examined him, but people with spinal stenosis have recurrent issues further down after the nerves are being pinched.''
White Plains neurosurgeon Ezriel Kornel agreed, saying: "It's probably not truly a pulled hamstring. It's probably more because there's nerve root irritation causing the muscle to cramp up.''
Dr. Drew Dossett, a spine surgeon at Carrell Clinic in Dallas who performed neck surgery on Prince Fielder, said surgery would be the very last step he would consider unless Wright met several criteria.
"It depends what the constellation of symptoms are,'' he said. "If there are symptoms that radiate into his lower extremities like sciatic nerve-type symptoms and you've been on appropriate medicines and injections and given physical therapy and that's not working and you're still having the symptoms, that's when you become a candidate for surgery.
"If it's mechanical back pain, if he says, 'My back hurts and that's why I can't do it,' it's very hard to make that better with an operation.''
Congeni, who also does not see surgery as an option based on what has been publicly made available about Wright's injury, has a guarded opinion on spinal stenosis.
"The long-term outlook of spinal stenosis is not good,'' he said, "and so in sports medicine, you have to know what are injuries people are going to recover from completely and what are things that are probably going to dog them for the rest of their career, and spinal stenosis is not a good one to be told you have.''
David Wright's injuries
On disabled list Aug. 17-Sept. 1 with concussion. Played 144 games.
On DL May 16-July 11. Stress fracture in back that Wright believed was sustained in April of that season when he dived at third to make a tag on Astros' Carlos Lee. Played 102 games.
On DL Aug. 30-Sept. 20 with strained right hamstring. Played 112 games.
Shut down Sept. 9 after prolonged problems with his left shoulder that originated after a head first slide on a muddy field in in June. Played 134 games.
Placed on DL list April 15 with strained right hamstring, followed by diagnosis of lumbar spinal stenosis. Has played 8 games.
With Marc Carig in Los Angeles