Cooling May Have Helped Save Everett's Spine

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."