NFL Draft Injury Impact: UCLA DE Laiatu Latu

04/18/2024
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Of all the variables to consider when evaluating a prospect, Latu’s medical history is by far the biggest concern. Following a cervical neck fusion in 2020 that forced him to medically retire while at Washington, Latu received a second opinion and transferred to UCLA. While he has avoided injury for the last two years, the concern is if there are neck issues above and below the surgical area moving forward. This could present as repeated stingers, disc herniations or progressive stenosis in the spine causing him to miss time. Latu’s talent makes him a first-round selection, but how long his career may be due to his neck could lead to a shortened career.

Laiatu Latu is one of the top defensive ends in the 2024 draft class. He also has one of the potential biggest medical questions that could affect his draft stock.

After starting his career in Washington, Latu was forced to medically retire due to a neck injury, sitting out of football for two seasons. Due to the diligence of his mother, Latu received a second opinion and was later cleared. After his position coach took a job at UCLA, Latu followed him down to Los Angeles. Once Latu returned to football, he made up for lost time over the last two seasons securing unanimous All-American honors along with the Lombardi and Ted Hendricks awards.

Regarded as a first-round talent, the Buffalo Bills could see Latu become a selection to bolster the defensive end room. However, this previous neck injury could have a significant impact on where he starts his professional career. The Bills have some level of interest in him as they recently brought him in for a top-30 visit.

Below is Laiatu Latu’s publicly reported injury history and whether he is a draft target for the Buffalo Bills.

Injury History

Middle School

Appendicitis, required surgery.

Latu underwent an appendectomy in middle school due to appendicitis. This is noteworthy as he implies this was the only surgery he had had in his life until college.

College

2019 Washington

Ankle injury, vs California, missed 1 game.

Latu suffered an ankle injury against Cal his freshman year. He suited up the following week versus Hawaii, but stayed on the sidelines.

Cervical fusion, required surgery, missed 2 seasons.

Latu suffered a neck injury during a routine practice, missing the entire four-game season during the pandemic-shortened year. After the season he underwent surgery, specifically a cervical fusion to address lingering numbness. According to Latu, the procedure did not work and after meeting with five different specialists around the country, it was determined that it was no longer safe to play due to potential paralysis, and was forced to medically retire.

2022-2023 UCLA

No publicly reported injuries.

Injury Analysis

According to Latu, “no teams have talked about any kind of concern” regarding his neck.

While Latu downplays the injury and potential concerns, there is a very high likelihood that some teams do have some concerns. Some may have even removed him from their draft boards. To understand why this injury may be a bigger issue, the anatomy must be reviewed.

The Anatomy

The neck is made up of seven cervical vertebrae that allow the spinal cord to pass through the middle, acting as a protective framework. This also creates the support necessary to support and maintain the head in an upright position.

Credit: AnatomyInfo.com

In between these vertebrae are intervertebral discs that help provide space for the nerves branching off the spinal cord to innervate their respective areas of the body. The discs also allow for the movement of the vertebrae over each other. This provides stability around the spinal cord and nerves but also allows for mobility for all neck movements.

Cervical Fusion

It’s known that he did undergo a neck fusion to address the lingering numbness but according to several reports, it did not work. He also had five different doctors who ultimately recommended that he medically retire from football.

However, Dr. Robert Watkins in Los Angeles medically cleared him and he was able to resume playing. Watkins is well-known within the NFL circles for performing orthopedic spine procedures such as fusions. According to various sources, Watkins performed surgery on Danielle Hunter and Peyton Manning, among many others.

The one question that is not answered is what was the original injury that necessitated a cervical fusion? Typically there are concerns of a bulging/herniated disc or cervical stenosis.

Both conditions could require a fusion if conservative measures are not effective. The anterior cervical discectomy with fusion is a procedure in which a surgeon enters the neck anteriorly, near the throat, to remove the herniated disc and fuse the vertebrae that were above and below where the disc was removed. The surgeon fuses this using a piece of extracted hip bone to create a bony spacer where the disc was prior. The surgeon then places a plate over the front that connects the two vertebrae to create the fusion.

Fusion Outcomes

The fusion reduces the pressure on the cervical nerves, leading to long-term stability. Within football specifically, that number for success is about 70 percent. There is also a chance for adjacent segment degeneration 10% of the time. This means that the level above and below the surgical area begins to have problems.

Credit: centenoschultz.com

Failure rates for ACDF where the surgical site fais vary anywhere from 2.1% to 9.13% for a single level in the general population, but for athletes, it is reported at 5.8%. A return to contact sports for a single-level fusion is acceptable with no long-term concerns though we see fewer games played compared to controls. If there are multi-level fusions, those are generally contraindicated for further contact sports.

When players do return, they play between 2.6 and 3.1 more years with no discernable drop-off in performance during that time frame. Keep in mind that when a player does return, they can return at their prior level of function but their career length can be affected.

Adjacent Levels

Reading all this, one might think, what’s the issue? The concern is once one level is fused, the adjacent levels above and below suddenly are tasked with accepting the stress and mobility necessary to move the neck. This causes adjacent segment degeneration. Rates vary between how long degeneration occurs from the time of surgery from 12 percent five years after surgery to upwards of 50 percent 10 years after surgery. When degeneration occurs, symptoms will not always begin immediately. These changes can then lead to other discs herniating or narrowing in other areas of the spinal canal. Mason West, a fellow physical therapist who covers the Chicago Bears shares similar sentiments.

While there are plenty of players who do have a successful outcome and play without incident, there’s a greater likelihood that many others have problems later. Whether it be repeated stingers, another disc herniation, or even further stenosis that causes persistent symptoms.

Credit: trialexhibitsinc.com

Injury Comparison

My comparable player for Latu is LB Leighton Vander Esch. Born with cervical spinal stenosis, he was able to play in college and later had a neck injury which was likely discovered at the initial diagnosis. This did not stop him from getting drafted in the first round of the NFL draft by the Dallas Cowboys. But Vander Esch would continue to have issues with his neck, requiring surgery and this is when he publicly revealed that he had the stenosis.

The neck issues followed him throughout his career requiring an additional procedure. Vander Esch ended up playing six years total in the league but was unable to pass a physical in 2024 which forced him to retire. Looking back at his contracts, the Cowboys declined his fifth-year option and then signed him to one and two-year deals, respectively. They were acutely aware of his issues and were likely hoping that they could keep kicking the can down the road.

Photo by Rob Leiter/Getty Images

This is the same concern I have with Latu. He’s already had one fusion and he’s had a variety of doctors tell him he shouldn’t play. As Latu underwent surgery in 2020 and then did not return to play until 2022, he avoided some of the hits normally seen right after the surgery. He has been able to play for two seasons without incident, but is his neck at risk for further issues once he gets into year three, four, five, and beyond?

There aren’t any specifics noting which level he had fused, but for several doctors to tell him he should retire suggests that he had an upper cervical fusion such as C4 or above. This would be a similar area to where former Bills C Eric Wood suffered his neck injury that forced him to retire. The big concern is that the phrenic nerve branches off the nerves in that area which innervate the diaphragm that controls breathing. The higher the spinal levels go, the more vital functions are impacted.

While the doctor who cleared him did both Danielle Hunter’s and Peyton Manning’s neck surgeries, both had wildly different outcomes. Hunter is still playing and Manning began to fall apart at the end of his career coming off the neck surgery. He was successful for that short timeframe but he had a shelf life of roughly the three years mentioned above.

Looking at another comparable in Micah Hyde is worth mentioning. The fan base saw his season end abruptly in 2022 due to a disc herniation that required a cervical fusion. While he did almost return for the playoffs that year, he was able to return in full for 2023. Regrettably, he began to have stingers following hits that caused him to miss practice and games throughout the season. Whether this was due to another herniated disc or stenosis is unclear, but the neck issues didn’t end with the fusion. Moving up another level of football and having the potential for more hits to the neck/head area could change this suddenly for Latu.

Other Observations

This could be blamed on coincidence, but the Bills have passed over players with cervical spine fusions including but not limited to DK Metcalf, Leighton Vander Esch, Justyn Ross, and Demone Clark. Who’s to say that they were who they were targeting at the time, but everyone was on the board for multiple rounds except LVE during the respective drafts. The only player that I can recall in recent memory that the Bills signed as a rookie with a lumbar fusion is UDFA Trey Adams back in 2020 who retired after a year of football.

One final thought, it’s interesting how the UCLA doctors allowed Latu to play with his neck injury. These are possibly the same doctors that had Miami Dolphins DE Jaelan Phillips medically retire due to concussions. While these are different injuries, the seriousness of each injury would lead someone to think there should be consistency between these decisions.

Bills Draft Selection

Looking at everything as a whole, Latu is a highly risky player for the Buffalo Bills to consider drafting early. The Bills are very risk-averse when it comes to injury in the first two rounds of the draft. Broken bones, minor sprains, and contusions are what they are comfortable with early on. I believe his injury is significant enough that even if he were to fall he would be completely off the Bills’ draft board as a medical failure.

Despite meeting with him, I believe the Bills did their due diligence by checking him out. They likely wanted to make sure they were not missing anything as to why they would not select him. Should Latu stay healthy but hit the open market once his first contract is complete, having the medicals on him could allow them to revisit their interest in several years.

This is why despite Micah Hyde and Liatau Latu having similar injuries, the Bills would take different approaches. Hyde was a proven commodity in the league when he signed and he did not have surgery at that point. It comes down to risk management with the Bills showing a greater willingness to work with veterans versus rookies coming in with medical concerns. Hyde requiring his fusion was unfortunate, but he was under contract and the short-term outcomes were acceptable enough to allow him to continue to play.

As it currently stands, Latu is medically cleared to play football. The concern is if and when the next neck injury occurs. That’s the risk I don’t believe that the Bills are willing to take.

Looking around the league, not every team has the same outlook as the Bills which means Latu will be drafted in possibly the late first round or early second round. It will be by a GM who thinks they are missing one final piece or by a GM who knows that he needs an impact player to save his job. However, if he begins to fall, we know the reason why.

Latu could play for 10 years and make that GM look like a genius. Or he could take another awkward hit in practice or a game, leading to further neck issues and an abbreviated career. Based on past draft trends and the current injury, the risk simply is too much for Brandon Beane to roll the dice on Latu no matter the talent.

Hopefully, Laiatu Latu will have a long and fruitful career, but the concern is still there for whoever drafts him.

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