The Road Back

Friday, December 14th, 2007

Tim Layden of Sports Illustrated has written about Kevin Everett’s devastating injury and The Road Back from paralysis:

On the first weekend of the 2007 NFL season, Everett fell limply to the Ralph Wilson Stadium turf after making a tackle on the second-half kickoff. He did not get up. The stadium fell silent, an ambulance drove onto the field, and players from both teams formed a prayer circle, the nightmare tableau that can unfold in any football game but is thankfully rare. Everett, a third-year player, had suffered a fracture dislocation in his neck and severe spinal cord damage. He would be the subject of grim prognoses (many victims of his injury, indeed, do not walk again) but also exhaustive and controversial medical care, including the groundbreaking use of a hypothermia treatment that has both encouraged and divided the medical community.

The details:

As Hixon started upfield, he angled toward the middle. Just past the 15-yard line he planted his right foot and prepared to cut outside, to his left. As he made the move, Everett arrived, shoulders squared, his body in an athletic crouch. Just before impact, Everett bent his upper body forward; Hixon dropped his upper body. The players collided violently, the crown of Everett’s helmet meeting the side of Hixon’s. “I’ve seen the play so many times, and it was the timing of it,” says Everett. “I did the same thing I would do every time running down on kickoff team, got low to put my pads under his, and this one time he lowered his helmet.”

Hixon was driven sideways by the blow, staggering to his right, where Aiken finished the tackle. Everett never saw that. “My body went numb instantly,” he says. “I thought he kept going because it felt like he ran smack over me.”

Everett’s body went limp, and he crashed to the artificial turf, flat on his stomach, his head turned to the right. He was motionless except for a momentary twitch of his head and neck as he tried to lift his paralyzed body off the ground with the only muscles in his body still firing.

Fifty yards from Everett, on the Buffalo sideline, stood Andrew Cappuccino, 45, an orthopedic surgeon with specialty training in disorders of the spine and for 13 years a member of the Bills’ staff under the team’s medical director, John Marzo. Eleven days earlier, on Aug. 29, Marzo and head trainer Bud Carpenter had led a 1 1/2-hour spinal cord injury refresher drill at the Bills’ field house in Orchard Park, N.Y. Cappuccino had nearly begged off — “I told Bud, ‘That scenario is never going to happen,’ ” recalls Cappuccino, who’d yet to encounter a spinal cord injury at a Bills game in his time with the team — but Carpenter insisted. Now that drill would form the foundation for the seminal moment in Cappuccino’s career. And in Everett’s life.
Cappuccino knew there was a flicker of hope. On the field he had applied forceful pressure to Everett’s lower extremities, from his ankles to his groin, and had detected a response that was absent with a sharp sensation such as a pinprick. This told Cappuccino that Everett had suffered an incomplete spinal cord injury, probably meaning that the cord was severely damaged but not severed.

Cappuccino then made two decisions, one that has reverberated through the medical world and one that has gone largely unnoticed but might have been just as critical.

First, he introduced mild hypothermia as a part of Everett’s care. In November 2006, Cappuccino had attended a seminar of the Cervical Spine Research Society and sat in on a talk by Dalton Dietrich, scientific director of The Miami Project to Cure Paralysis. Dietrich devoted the last 10 minutes of his presentation to the potential benefits of induced hypothermia for neuroprotection — the rapid cooling of the body to reduce metabolic demand and to prevent further damage from swelling and other inflammatory mechanisms. It is a controversial treatment that has not been established as a standard of care in spinal cord injuries and is the subject of considerable debate in the field. Partly motivated by that talk, Cappuccino had instructed the EMTs at Bills games to stock their ambulance with three bags of saline solution in a cooler. [...]
Second, Cappuccino instructed Lengel to drive to Millard Fillmore Gates Circle Hospital. Normally a player injured in a Bills game would be taken to Buffalo General, about a mile closer, but Cappuccino knew that Gates has magnetic resonance imaging (MRI) technicians on duty 24 hours a day. This is rare, and with Gates’s in-house CT scanning capability it would enable swift diagnosis of Everett’s injury. The hospital also is the only one in Buffalo with a neurosurgical intensive care unit, under the direction of Dr. Kevin Gibbons, 47.

Everett arrived at the hospital about 35 minutes after the hit. X-rays and CT scans showed a fracture dislocation of Everett’s cervical vertebrae at the C3/C4 level, meaning that one vertebra had slipped out of alignment and was compressing against its adjacent vertebra and the spinal cord in the neck. An MRI showed that Everett’s spinal cord was 70% to 75% compromised, or pinched, by the dislocation.

Cappuccino and Gibbons, assisted by senior neurosurgical resident Ken Snyder, worked to reduce the dislocation. A halo device was screwed into Everett’s skull, and while he remained awake, manual pressure and traction weights were used to realign the vertebrae and remove pressure from the pinched spinal cord. Next would come 4 1/2 hours of surgery to stabilize Everett’s vertebrae and further decompress the spinal cord. Both the reduction and the stabilization surgery are common practices in spinal cord injuries and clearly were vital elements of Everett’s care. [,,,]
Everett was placed on the CoolGard in the predawn hours of Monday, Sept. 10, and within two hours his body had cooled to a temperature of 91.5°. That morning Everett was able to squeeze his thighs against Cappuccino’s hands. “Everybody was stunned,” says Cappuccino, “including me.”
Twelve days after an injury that could have left him in a wheelchair for life, Everett flew to Houston to begin rehab. Less than a month later he would be walking with assistance.

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