Interesting medical treatment - NFL Paralysis

[Space Cadet B^3]

I'm quoting the whole article, but really want to point out the science side so look for boldings

Neurosurgeon: Bills' Kevin Everett moved arms and legs, which means he could walk again
By JOHN WAWROW, AP Sports Writer
September 12, 2007

BUFFALO, N.Y. (AP) -- Kevin Everett voluntarily moved his arms and legs on Tuesday when partially awakened, prompting a neurosurgeon to say the Buffalo Bills' tight end would walk again -- contrary to the grim prognosis given a day before.

"Based on our experience, the fact that he's moving so well, so early after such a catastrophic injury means he will walk again," said Dr. Barth Green, chairman of the department of neurological surgery at the University of Miami school of medicine.

"It's totally spectacular, totally unexpected," Green told The Associated Press by telephone from Miami.

Green said he's been consulting with doctors in Buffalo since Everett sustained a life-threatening spinal cord injury Sunday after ducking his head while tackling the Denver Broncos' Domenik Hixon during the second-half kickoff of the Bills' season opener.

Everett dropped face-first to the ground after his helmet hit Hixon high on the left shoulder and side of the helmet.

Everett remains in intensive care at Buffalo's Millard Fillmore Gates Hospital and will be slowly taken off sedation and have his body temperature warmed over the next day, Green said. Doctors will then begin taking the player off life support systems -- including a respirator -- currently controlling his body functions.

"It's feasible, but it's not 100 percent predictable at this time ... he could lead a normal life," Green said.

On Monday, Bills orthopedic surgeon, Dr. Andrew Cappuccino, said Everett likely wouldn't walk again.

"A best-case scenario is full recovery, but not likely," said Cappuccino, who operated on the reserve tight end. "I believe there will be some permanent neurologic deficit."

Cappuccino was not available Tuesday, and hospital spokesman Mike Hughes declined comment.

In a report Tuesday evening, Buffalo's WIVB-TV quoted Cappuccino as saying: "We may be witnessing a minor miracle."

Bills owner Ralph Wilson said the team has been in contact from the beginning with Green and the Miami Project, the university's neurological center that specializes in spinal cord injuries and paralysis.

"I don't know if I would call it a miracle. I would call it a spectacular example of what people can do," Green said. "To me, it's like putting the first man on the moon or splitting the atom. We've shown that if the right treatment is given to people who have a catastrophic injury that they could walk away from it."

The encouraging news might have come as a surprise to many, but not to those who know Everett well.

Buffalo Bills team doctor John Marzo, right, and Millard Fillmore Gates hospital orthopedic surgeon Andrew Cappuccino listen to a question during a news conference on the condition of Bills football tight end Kevin Everett at the Ralph Wilson Stadium complex in Orchard Park, N.Y., Monday, Sept. 10, 2007. evin Everett during a news conference at the Ralph Wilson Stadium complex in Orchard Park, N.Y., Monday, Sept. 10, 2007. Cappuccino said Everett sustained a "catastrophic" and life-threatening spinal-cord injury and his chances of regaining a full range of body motion are very small.

Al Celaya, who coached Everett at Thomas Jefferson High in Port Arthur, Texas, was confident his former player would battle through.

"When faced with any adversity, Kevin is going to put out the effort, he's going to work hard and he's going to find a way to win," Celaya said. "I think Kevin will be that kind of person, because that's the kind of person he's always been."

Intending to play basketball, Everett was persuaded by Celaya to give football a try. Some nine years later, and after two seasons at the University of Miami, Everett was Buffalo's third-round pick in the 2005 draft.

"He overcame a lot of odds to do that," Celaya said.

Green said the key was the quick action taken by Cappuccino to run an ice-cold saline solution through Everett's system that put the player in a hypothermic state. Doctors at the Miami Project have demonstrated in their laboratories that such action significantly decreases the damage to the spinal cord due to swelling and movement.

"We've been doing a protocol on humans and having similar experiences for many months now," Green said. "But this is the first time I'm aware of that the doctor was with the patient when he was injured and the hypothermia was started within minutes of the injury. We know the earlier it's started, the better."

Cappuccino said Monday that the 25-year-old did have touch sensation throughout his body, showed signs of voluntary movement and was able to breathe on his own before being sedated. But he cautioned that Everett's injury remained life-threatening because he was still susceptible to blood clots, infection and breathing failure.

Green noted that Everett and Wilson have ties to Miami and the Miami Project -- Everett played there and Wilson is one of the project's largest donors.

"It's an amazing group of circumstances. It's a home run. It's a touchdown," Green said.

This could be huge in trauma cases... I wonder how they work off the shock and do this, one report I heard says it's like an ice pack on a bruise, that swelling and inflammation doesn't become the same factor, and I'd imagine in spinal cases, the less inflammation the better.

Just thought this sounded pretty advanced.

[PWD]

He's fantastically lucky he had a doctor right at hand with both the knowledge and the means to treat him.

Unfortunately that's highly unlikely for the rest of us, but it's an amazing turn of events. It makes me ill whenever I see football players with such devastating injuries. There but for the grace of god and all that...

[Northcott]

Unlikely for the rest of us... but it moves society a step closer to that kind of solution being a part of standard emergency medical procedure. Science for TEH WIN!

[Space Cadet B^3]

Oh don't get me wrong, I know it's far away from being something that will be in common use, but I think it might represent an advance in treatment of catastrophic spinal injuries.

Science is so freakin' cool. :)

[Space Cadet B^3]

More info:

Cooling May Have Helped Save Everett's Spine
Some Say Experimental Therapy Helped; Other Doctors Uncertain
By SUSAN KANSAGRA, M.D. and DAN CHILDS
ABC News Medical Unit

Sept. 12, 2007 —

When paramedics wheeled Buffalo Bills tight end Kevin Everett into Buffalo's Millard Fillmore Hospital Sunday, a life-threatening spine injury had rendered him functionally quadriplegic -- and potentially paralyzed for life.

But an experimental treatment may have drastically improved his chances of walking again, according to some doctors.

The treatment, which involves an infusion of ice-cold saline, nudges the body into a state of hypothermia -- a step aimed at limiting the cascade of events in the body that can lead to further spinal cord damage after an injury.

Dr. Kevin Gibbons, one of the neurosurgeons at Millard Fillmore Hospital who operated on Everett, said at a press conference Wednesday afternoon that his team had decided to go forward with the cooling after Everett's body temperature rose dramatically after his injury.

"Although we are not sure that cold temperature is good, we know high temperature is bad in a neurological injury," Gibbons said.

But the procedure may have done more than simply cool Everett down; it may also have helped limit the damage caused by the injury.

And now that Everett has regained a small degree of movement in his ankles, legs and arms, some doctors say the hypothermia treatment may have saved the football star from further impairment.

"I think there is great potential for the use of hypothermia," said Edward Hall, director of the Spinal Cord and Brain Injury Research Center at the University of Kentucky's Chandler Medical Center. "The work that has been shown to show the effect of hypothermia in animal studies has been first-rate. They've shown very clearly that it can work in experimental models."

However, a number of neurologists point out that the controversial treatment is still largely unproved and has not been widely tested in humans.

"I was very surprised to hear about the recovery scenario of Mr. Everett," said Stephen Scheff, professor of anatomy and neurobiology at the University of Kentucky. "Cooling of the system is somewhat controversial, and some of the most well-controlled experiments, such as those performed at the Miami Project, have shown it doesn't work well."

Cool Approach to Dangerous Injuries

Everett, 25, sustained the spinal cord injury during the Bills' season opener Sunday at the start of the second half after tackling the Denver Broncos' Domenik Hixon.

The Bills' team orthopedic surgeon, Dr. Andrew Cappuccino, announced a day after the accident that chances were slim that Everett would ever walk again.

But Tuesday, Everett moved his arms and legs under his own volition when partially awakened -- a promising sign that suggested he may be able to overcome the initial prognosis of permanent paralysis.

As for exactly how cooling down the body may help ward off paralysis, doctors are still unclear. But researchers theorize that hypothermia may protect sensitive nerve tissues by slowing down certain chemical reactions in the body that lead to swelling and irritation -- processes that have long been viewed as partial culprits in spinal nerve death.

The idea of inducing hypothermia to limit the damage caused through spinal injuries is not a new one.

Researchers with the Miami Project to Cure Paralysis are performing much of the current research into the potential treatment. Dalton Dietrich, professor of neurological surgery at the Miami Miller School of Medicine and scientific director of the Miami Project, said the use of hypothermia goes back as early as the 1960s for cardiac procedures -- though the side effects associated with drastically cooling people down were considerable.

Now, Dietrich said, researchers are looking toward a more modest cooling effect to prevent further nerve damage after a spinal cord injury.

"Over the last 15 to 20 years, in experimental models of brain and spinal cord injury, we have shown that modest cooling -- 2 to 3 degrees centigrade -- is protective and improves outcome," he said.

The fact that treatment began so soon after the injury may have made a big difference.

"The window of opportunity to introduce hypothermia may be relatively short," Dietrich said. "Hypothermia and other treatments have to be initiated early after injury. Thus, unless patients get to the hospital within two to three hours, many therapies are no longer potent in terms of targeting the injury mechanisms that they are directed toward."

A Medical Miracle?

Other doctors, however, cautioned that it is too early to say exactly how much the treatment helped.

Some say other factors may have also played a role in his improved prognosis. Injection of the steroid methylprednisolone, which Everett is also believed to have received, could have limited the swelling that follows spinal injury. And Everett's spine was repositioned quickly following the incident -- another crucial step.

"That may be what helped the most," said Dr. Thomas Balazy, a spinal cord injury team supervisor at Craig Hospital in Colorado. "They got him to the acute care hospital, and then aligned his neck, decompressed the cord and took the pressure off it, and stabilized his neck."

Most of the controlled experiments to determine the effectiveness of hypothermia as part of medical treatment have so far been done only on animals, though a handful of human case reports exist.

"Hypothermia is often listed as a promising neuroprotective therapy but one that needs further clinical testing before it should be used as a standard of care in treatment of spinal cord injuries," said Naomi Kleitman, director of the Repair and Plasticity Program at the National Institute of Neurological Disorders and Stroke.

And hypothermia isn't without its dangers. Even modest cooling of the body can have significant health effects.

"Overcooling or prolonged hypothermia can have some detrimental effects on organs that require higher blood flow to respond to the stress of the neurological injury," said Dr. Michael Haak, assistant professor of orthopedic surgery at the Feinberg School of Medicine of Northwestern University.

"Sometimes you get into problems such as blood clotting and other side effects related to blood disorders," Hall added.

The Prognosis Now

For now, Everett remains in intensive care, though he is awake and communicating with his family. Though doctors remain hopeful, only time will tell whether he will recover fully.

"These cases are extremely complicated, and it will take several weeks to determine the extent of Mr. Everett's conditions and potential for recovery of function," Dietrich said.

However, he said that Everett's case could represent one more step in understanding how inducing hypothermia may help those with spinal cord injuries.

"A lot of the therapies that we have been trying for the last 10 years have failed clinical trials," Dietrich said. "The future of therapies is that we can use mild hypothermia in combination with some of these drugs [to] actually produce a beneficial effect."

And together with the other treatments, the therapy may have gone a long way in preserving Everett's function.

"It is likely that this specific patient benefited from early management, including the moderate hypothermia, early decompression of the spinal cord through the surgery and stabilization of the damaged spinal segments, and demonstrated with the movement of his arms and legs that he had an incomplete spinal cord injury," Haak said.

"This type of injury has a good potential for neurological improvement over time, and is great news for the patient, his family and friends, and the medical team that is caring for him."

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