Peyton Manning underwent more neck surgery Thursday, the third time in the last 19 months, and will miss not only the season-opening game but possibly the entire season.
Losing Manning for any stretch of time is a huge blow to the Indianapolis Colts and throws the race for the AFC South wide open. The NFL's only four-time MVP hasn't missed a game in 14 seasons, with 227 consecutive starts, including the playoffs.
"Rehabilitation from such surgery is typically an involved process," the Colts said in a statement, calling the procedure "uneventful."
"Therefore, there will be no estimation of a return date at this time," it continued. "We will keep Peyton on the active roster until we have a clear picture of his recovery process."
The statement came just hours after Colts owner Jim Irsay wrote on Twitter that his 35-year-old quarterback would be out "awhile" and coach Jim Caldwell promised to provide more clarity. The Colts could have put Manning on season-ending injured reserve to open up a roster spot, but that would have meant he wouldn't play at all in a season that will end in February with the Super Bowl played at Lucas Oil Stadium in downtown Indianapolis.
NFL's Network's Michael Lombardi reported Thursday that Manning traveled all over the country in an effort to find a solution for his cervical problem, with the latest recommendation resulting in surgery. Colts officials said Manning had an anterior fusion procedure to treat the nerve problem that was continuing to give him trouble months after his May 23 surgery.
The Colts didn't provide any more details, but such a procedure usually involves making an incision in the front of the neck, removing soft disk tissue between the vertebrae and fusing the bones together with a graft. The goal is to ease pain or address a disk problem.
Recovery typically takes at least eight to 10 weeks, said Dr. Victor Khabie, co-chief of the Orthopedics and Spine Institute at Northern Westchester Hospital in New York. He didn't treat Manning, but he's familiar with the procedure and how athletes recover from it.
"It could be season-ending, seeing the piggybacking off of another surgery," Khabie said. "But the athletes I've known over the years, I never count out because they are such great competitors and such great healers."
Dr. Andrew Hecht, director of spine surgery at Mount Sinai School of Medicine in New York, doesn't believe the injury will prematurely end Manning's career.
Hecht, who works with the New York Jets and NHL's New York Islanders, said the biggest risk is healing. He said it typically takes three months for the fusion to occur, though some people heal faster.
"The odds are that he'll end his career when he wants to end his career," Hecht said.
Manning, who signed a five-year, $90 million contract in July, also had neck surgery in February 2010. The Colts said Manning will begin his latest rehab stint immediately.
For now, the Colts don't appear interested in other quarterback options beyond Kerry Collins, the 17-year veteran who signed in late August as an insurance policy. According to a tweet by Sports Illustrated's Peter King, Colts president Bill Polian said he isn't interested in signing David Garrard, who recently was released by the division rival Jaguars.
For Manning, one of the league's true ironmen, it's a continuation of the most frustrating offseason of his career.
He already has dealt with a 4½-month lockout that prevented him from working out with team trainers after his surgery to repair a nerve. He also couldn't negotiate a new contract with the Colts during the lockout. Then he started training camp on the physically unable to perform list, which prevented him from working out with teammates until Aug. 29.
After one week of practice, Manning left with a sore back. And now he had surgery only one day after the Colts ruled him out of Sunday's game, ending a consecutive starts streak second only to Brett Favre among NFL quarterbacks.
"We still have to show up on Sunday and take on the Texans," longtime Colts center Jeff Saturday told NFL Network. "With or without Peyton, we still have to show up and play. Obviously, I'm disappointed. He's one of my close friends. I'm sad for what he's going through. But we have a job to do, and that is to go down and beat the Texans and get a division win in Week 1."
With Manning, the Colts have been a perennial Super Bowl contender. Without him, the most dominant team in the AFC South since its creation faces a daunting challenge: trying to become the first team to play a Super Bowl in its home stadium without having Manning behind center for what could be a significant portion of the season.
"I think a lot of us knew it was pretty serious the other day when they brought Kerry (Collins) in, we knew things weren't progressing at the rate they would have wanted," Saturday said. "Obviously, I'd want him to come back as soon as he's healthy and as soon as possible. I've played with him my whole career, and he's a heck of a quarterback and obviously a huge part of our team and helped lead us to a bunch of victories. The reality is we got to hold down the fort for as long as he's not here."
Speculation over another surgical procedure ramped up earlier this week, and Irsay created even more buzz Thursday morning when he gave fans the latest update on Manning's condition via Twitter.
"We had a good practice yesterday and r guys r fired up 4 the season," Irsay tweeted. "(hash)18's out for awhile, but compete, we will/BELIEVE."
The biggest question is when Manning will be back.
The Colts believed Manning would return within six to eight weeks after the second surgery, but the rehab has taken far longer than anyone expected. On Monday, the team issued a statement saying Manning's progress slowed last week, too.
"In terms of the timeframe we're talking about, I think he (Irsay) is also stating we don't know what kind of a timeframe. None of us know," Caldwell said before the surgery was announced. "It is a little bit in flux at this point."
Khabie said the fact Manning has had neck surgery three times in such a short period is reason for concern.
If Manning does return this season, he also will play behind a revamped line that features three new starters and a fourth playing a new position, as longtime right tackle Ryan Diem has moved inside to guard.
There were times, Addai recalled, that he would wake up during the night with sudden pain. There were other times he couldn't hold up a microphone or the ball would drop out of his hands with a slight bump.
Addai figured the ensuing bye week would give him enough time to heal, but it took him more than two months to get back into a game, and he still didn't feel 100 percent until this season.
"After a while, it came back, but you don't really know when it's going to come back," Addai said. "It's frustrating."
Addai said Manning asked him about the experience, something the two discussed at length since players reported to camp July 31.
Addai said he's worried about playing the Texans without Manning.
"You know how important Peyton is," Addai said. "I think everybody has to step it up."
"To say I am disappointed in not being able to play is an understatement," Manning said in a release sent out by the team Wednesday. "The best part about football is being out there on the field playing with my teammates. It will be tough not to be out there playing for the organization and our fans. I simply am not healthy enough to play, and I am doing everything I can to get my health back. The team will do fine without me, and I know for sure that I will miss them much more than they miss me."
The only other time Manning has missed a regular-season snap because of injury was in 2001 against the Miami Dolphins. Backup Mark Rypien fumbled the ball, and the Dolphins recovered it and drove 59 yards for the winning score. Manning returned on the next series with a bloody mouth. He later was diagnosed with a hairline fracture in his jaw.
Manning, who rarely misses a snap even at practice, occasionally has been sidelined during the preseason.
Manning sat out one week of training camp in 1998 before signing his rookie contract. A decade later, he missed all of training camp after having surgery twice to remove an infected bursa sac from his left knee. He also missed some practices after injuring his knee during a 2001 preseason game against the Minnesota Vikings.
Since being drafted with the No. 1 overall pick in 1998, Manning has led the Colts to 11 playoff appearances, 11 double-digit winning seasons, eight division crowns, two AFC titles and a Super Bowl championship.
The Associated Press contributed to this report.