Buffalo Bills player spinal cord recovery

by Ben Mauk

September 14, 2007

An experimental procedure used to treat patients following cardiac arrest or a stroke may have contributed to the ongoing recovery of Buffalo Bills tight end Kevin Everett, who remains hospitalized following a severe spinal cord injury suffered September 9, in the team’s NFL opener with the Denver Broncos.

Everett, 25, had been feared permanently paralyzed after he tackled Broncos wide receiver Dominik Hixon as part of the Bills’ kickoff coverage special team, a move that resulted in the fracture and dislocation of Everett’s spine. The Bills tight end suffered the direct compression of his spinal cord between the third and fourth cervical vertebrae.

Within minutes after Everett was removed from the field, doctors induced hypothermia to reduce potential swelling and inflammation that may have caused permanent damage. Later, after intensive spinal surgery under sedation, Everett moved his arms and legs Tuesday, contrary to the expectations of his doctors.

His condition is still uncertain, but if he continues to recover, he may want to thank the research team at The Miami Project to Cure Paralysis, a spinal-cord research center at the University of Miami Miller School of Medicine.

“My colleagues and I have spent 20 years researching the beneficial effects of modest hypothermia,” or lowering the body’s temperature “just a couple of degrees,” said W. Dalton Dietrich, scientific director of the Miami Project.

Clinical trials of inducing hypothermia in patients with cardiac arrest and stroke have been conducted internationally in recent years. The University of Miami, one of the few places studying hypothermia treatments in acute spinal injury subjects, has been conducting trials for two years. But this high-profile injury was unique in the rapid treatment Everett received.

Severe injuries to vertebrae C-3 and C-4 not only result in decreased sensation below the injured area and a decreased ability to move limbs, but can also lead to the inability to breathe on one’s own, said Dietrich, as well as “a variety of…autonomic problems, including heart rate, blood pressure and temperature control.”

“It not only affects the axons [of nerve cells] going up and down the spinal cord, but also important cells at that level. It is devastating. Twenty years ago a lot of people did not live because of this injury.”

Orthopedic surgeon Andrew Cappuccino began the hypothermia treatment on Everett a mere 15 minutes after the injury, much shorter than the typical one to three hours seen in clinical trials.

“This may be a world record,” said Dietrich.

The process began in the ambulance, where two IVs were inserted into Everett containing an ice-cold saline solution, which lowered his body temperature to a reported 92 degrees.

The solution put Everett into a hypothermic state, which reduced the damage to the spinal cord caused by swelling and movement.

“After spinal cord injury there is a lot of swelling,” said Dietrich. “Swelling is bad because it compresses blood vessels, and the nervous system does not like to be under pressure.

“Hypothermia reduces swelling and reduces the amount of inflammation. We are also working in the lab on how hypothermia slows down apoptotic cell death mechanisms.” These complex processes, carried out within the cell, systematically break down the cell  following the presence of certain proteins and signaling events; these apoptotic processes  can be manipulated by changing the surrounding temperature.

“That’s what’s important about hypothermia—it doesn’t target one method of cell damage, it probably targets most.”

Everett also received methyprednisolone, an anti-inflammatory steroid commonly given to patients with spinal cord injury.

Nevertheless, Cappuccino told reporters the Monday after the game that Everett had suffered a life-threatening injury and that he stood a mere 5 to 10 percent chance of regaining a full range of motion.

The surgeon happily recanted his prognosis after Everett’s unexpected activity, bringing to light the uncertain nature of spinal cord injuries, in which movement in the first 72 hours is a crucial clue to the likelihood of recovery.

“Based on our experience, the fact that he's moving so well, so early after such a catastrophic injury, means he will walk again," consulting neurosurgeon Dr. Barth Green, president of the Miami Project, told the Associated Press.

But whether this recovery is due to the quick administering of the slight hypothermia treatment or of methyprednisolone, some combination of the two or simply a cocktail of good clinical care and good fortune, “is an important issue we will not know the answer to from this case,” said Dietrich.

“Certainly early treatment with any drug, or in this case hypothermia, you would expect a better result. It may be a factor.”