The relationship between the Buffalo Sabres and captain Jack Eichel appears to have completely deteriorated over the last few months.
The speculation over Eichel's unhappiness in Buffalo has swirled for some time now with the team currently riding its 10-year playoff drought. But things escalated pretty quickly during his end-of-season conference call when the 24-year-old aired some dirty laundry, saying there was a "disconnect" between him and the team over the handling of the treatment of a herniated disk in his neck.
From that point, Sabres general manager Kevyn Adams has been actively talking to teams around the league who have inquired about Eichel's services.
Adams has approached this offseason with a mentality of finding players for his team that want to be in Buffalo and play for the Sabres going forward. Players like Sam Reinhart and Rasmus Ristolainen have already been moved this offseason after expressing their disinterest in taking part of another rebuild in Buffalo.
However, Eichel remains on the roster, as Adams has dug in with trade negotiations to get the best possible value in a potential return for the former second overall pick of the 2015 NHL Draft. While Adams says he's not going to let any distractions influence him to trade Eichel, the center's representatives have now openly expressed their displeasure with the organization, saying, "The process is not working."
Perhaps the one factor that has led to the Sabres holding on to Eichel for this long has been the asking price in a trade, which has been reported by multiple outlets to be the equivalent of four first round assets. This had led many teams to take a step back in negotiations with the Sabres, leaving the market eerily quiet to this point.
Another major factor that ties into the value of a potential deal is the current health status of Eichel.
From the start of his recovery process, Eichel has been looking to undergo an artificial disk replacement surgery that would help him have a quicker recovery period and get him feeling healthy and back on the ice sooner. However, this type of surgery has never been done on a National Hockey League player, which has thrown up the red flag for Adams and the rest of the Sabres organization.
Adams has said throughout the offseason that the team does not feel comfortable with the procedure Eichel wants to have done. On top of that, the collective bargaining agreement gives the Sabres the final say on whether or not Eichel is allowed to proceed with any surgery.
Although Eichel's agents, Peter Fish and Peter Donatelli, said that Eichel had a lapse in the prescribed period for conservative rehabilitation in early June, he has been working out and continuing to stay active during the offseason. This included a recent skate in Boston, where he was seen on the ice at the Bruins' training facility at Warrior Ice Arena.
While Eichel continues to work this offseason, his short-term future remains unknown both with his health and his status with the Sabres going forward. Adams has said that he would be fine with Eichel remaining on the roster come the opening of training camp in September, but that possibility doesn't seem anything like a foregone conclusion.
As the debate over Eichel's future continues, so does the possibility of an artificial disk replacement surgery, even though hit as never been done on a player at the NHL level. But is this procedure the best option, at this point, to allow Eichel to get back to 100% and ready for whatever comes next?
According to neurosurgeon Dr. Chad Prusmack, Eichel is going to need some sort of surgery to repair the damage done to his neck.
"That disk injury is causing impingement of neurologic structures, and it hasn't responded to conservative care, meaning physical therapy, sports therapy, etc.," Dr. Prusmack said on Sportsnet's "31 Thoughts: The Podcast" with hosts Jeff Marek and Elliotte Friedman. "He's still symptomatic, and follow up scans have shown this persistent issue. So I believe there's a unanimous sort of understanding that he needs a surgery."
Dr. Prusmack has worked with a number of hockey players in the past out of his home base in Denver, Colorado. He has worked independently with NHLers, whether it would be for concussions, neck evaluations or other performance issues. Prusmack has been working with Eichel throughout the process and would actually be the neurosurgeon to perform the surgery on Eichel.
He says he has also served as an independent consultant for the Denver Broncos of the National Football League for the past 17 years.
There are two types of surgery that Eichel could undergo to repair the herniated disk in his neck: An anterior cervical discectomy and fusion (ACDF) or an artificial disk replacement (ADR).
While both procedures have their pros and cons, Dr. Prusmack explains that for an athlete like Eichel, an ADR may be a more suitable route.
"The fusion is a very good success rate, and the success rates for both of them are in the [90% range]," Dr. Prusmack said. "However, it's been well-documented in the literature with an ACDF, sometimes the bones don't heal, sometimes the screws and instrumentation extrudes or fails, and then has a bit of a higher complication rate.
"With an artificial disk, you're not waiting for anything to fuse. The neck is already moving. It's just the opposite [of a fusion]. You want their neck to move so you can sort of lubricate that joint."
Here is more of what Prusmack had to say on "31 Thoughts: The Podcast" pertaining to the treatment options for Eichel this offseason:
Prusmack on the recovery timeline for an ACDF vs. an ADR:
"The average, when you look at the meta-analysis, is somewhere in the 7, 8, 9 month range. That's a big difference, because the type of post-operative instructions I give to a patient with an artificial disk is almost the opposite. I say move your neck normally right after surgery. We're going to do low-impact exercises, core exercises and physical therapy for six weeks. At six weeks, if the x-rays look good then you look good. It's around that time where the bone actually grows into the disk, so it's not going to come out, and the patient can return to performance at that time."
"So training at full velocity, no contact at Week 6, and then potentially contact at somewhere between Weeks 8-12. But that's more of a return to performance thing based off the strength and conditioning coaches, the [physical therapy], mobility and stuff like that."
Prusmack on the worry that an ADR has never been done to an NHL player before:
"Using the statements that, 'Well, in the NHL, it's never been done,' from a risk-management standpoint, that's great. But from this young adult standpoint, that's not optimal. I think that [Eichel] would perform better. I think he will have a better outcome. I think he will be more of the natural elite athlete he is restoring the motion that he earned from all of his workouts and all of his brain-body connections. Let's restore the motion so he can perform at the elite level that he does.
"The fact that it hasn't been done in an NHL hockey player; it has been done in hockey players, just not in the NHL, is important because I don't think that's an argument or you would never make medical advances in any rhyme or reason."
Prusmack on the ADR procedure with other professional athletes:
"This is done and published in rugby players for several years. The artificial disk has been put in UFC champions who have fought several fights, and just mind you, they're getting kicked in the head, they're getting neck cranks. They're getting forces that are completely different than hockey, and they're battle tested. ... When people would get 'laid out,' it's like a whip. Their head gets whipped back and so forth. That's what the artificial disk is made for. It's made to handle motion, it's made to handle those movements. That's why athletes do so good with it."
Prusmack on why an ADR procedure would be beneficial to Eichel:
"When you look at the artificial disk, it offloads the adjacent level. It becomes mobile. Now that mobility gets to distribute the load and the motion and the performance around his neck. So there is no adjacent levels or segment problems. It's a one-and-done surgery, most of the time. I think that the 10-year follow up study showed somewhere in the 4.8% re-operation rate for an ADR, relative to in the [20% range] for ACDF."
"I respect all of the spine and neurosurgeons who have weighed in on this, and he's been seen by good doctors, The vantage point with which we make decisions as doctors, I have one invested interest: It's the well-being today, to perform, and for the life of Jack Eichel. That's what's important, and I have to see that 360-degree view of his future, because I'm the one that has the experience in having done over a 1,000 of these [procedures]."
You can listen to the entire podcast with Dr. Prusmack here: