When a double-flip gone awry left gymnast Jorge Valdez, 20, paralyzed with a dislocated neck, doctors feared he would never walk again. But just seven days after surgeons opted for a still-experimental treatment involving induced hypothermia, Valdez walked out of the hospital.
Valdez was practicing a double flip while making an audition video for the Las Vegas Cirque du Soleil when he misjudged his rotation and landed on his head, dislocating his C6 and C7 vertebrae.
"I was unable to move after that, I couldn't feel my legs. I could only open and close my hands a little," Valdez, a Miami native, says. "I was scared. I've been injured before pretty bad, but nothing this bad."
He was airlifted to Jackson Memorial Hospital in Miami, where doctors determined he was a candidate for a cooling procedure that is thought to slow spinal cord damage by reducing swelling at the injury site.
Valdez was a good candidate for cooling because he had an isolated injury and he was a healthy guy with no other medical conditions, says Dr. Steven Vanni, a neurosurgeon at the University of Miami, who treated Valdez. Though he had been able to move his arms after the injury, by the time he was brought to Vanni, he had no motor or sensory function below his neck, making it difficult to predict how much function he would ultimately recover.
"He told my dad he couldn't guarantee that I'd be able to walk again," Valdez says.
After surgeons removed the disc that was pressing on the spine and fixed the dislocations, a catheter cooled by chilled saline was inserted into Jorge's groin. The chilled catheter cooled down his blood as it passed through it, his internal body temperature down to about 92 degrees Fahrenheit. He was kept in a medically-induced coma and in that hypothermic state for 48 hours post-operation.
"I woke up and thought it was the day of the surgery [Thursday], when really it was Saturday," Valdez says. By that Wednesday, he was walking on his own.
Now out of the hospital, Valdez's physical therapy focuses primarily on his hands, where he has some nerve damage and doctors say he will
Hypothermia and Injury Damage Control
While Valdez case makes hypothermic treatment seem like a miracle-maker, the evidence in support of this chilling treatment as standard of care for spinal injuries like this is still inconclusive says Dr. Andrew Hecht, an orthopedic surgeon at Mount Sinai Medical Center.
While surgeons are hoping that hypothermic treatment turns out to be the next big advance in neurological injury, the verdict is still out, he says. The fact that Valdez still retained some motor function and was seen so quickly by medical professionals are the most important factors in him making the near-full recovery he has so far, Hecht emphasizes, though it's possible that the hypothermic treatment enhanced it.
Though therapeutic hypothermia has been used in other cases, such as following a cardiac arrest, since the 1970s, it is not a widely used treatment for spinal cord injury, says Dr. Roger Humphries, chair of emergency medicine at the University of Kentucky.
The use of hypothermia for spinal cord injuries garnered public attention in 2007 however after Buffalo Bills tight end Kevin Everett was treated with it following an injury during a game. Neurologists feel that the cooling may have prevented him from further injury and aided his ability to come back from what was effectively a quadriplegic state.
"There are different theories for why it might work. It's thought to be protective against some of the inflammation and the low blood flow that can happen with spinal cord injuries. But there need to be large trials before we can know how effective it is," Humphries adds.
There are also potential complications associated with pushing the body into hypothermia, Hecht notes, such as increased susceptibility to infection, risk of blood clots, and cardiac arrhythmia.
In cases where patients are otherwise healthy besides the acute injury, the potential benefit of cooling treatments are weighed against these potential risks. Though more research is needed to determine how much of an impact therapeutic hypothermia has on cases like Jorge's, Vanni says that Jorge's recovery "helps add evidence that this is something that needs to be looked at in a more universal arena."
More Research Fuels Chill Therapy
"This is a question not only of did he walk but how quickly he walked and how little residual injury he had," he adds.
As for Jorge, he says he feels "very, very lucky" to have had such good medical attention and such a speedy recovery.