For injured athlete, key is rapid treatment

The Baltimore Sun

When Buffalo Bills tight end Kevin Everett damaged his spinal cord during a football game Sunday afternoon, his only hope was the state-of-the-art medical treatment he received within a remarkably short time.

Despite grim initial assessments of his chances for recovery, there were signs yesterday that aggressive treatment might have worked. The surgeon who operated on Everett said that his patient had voluntarily moved his arms and legs and that he was optimistic that Everett will walk again.

Still, experts said, the severe neck injury Everett sustained making a "heads-down" tackle puts the 25-year-old at risk for life-threatening infections and blood clots.

The kind of injury that occurred during the televised game is the nightmare of teammates and of families who watch their loved ones play football with the knowledge that the worst can happen and occasionally does. It is also the nightmare of coaches who drill their players in "heads-up" tackling from the first day, specifically to prevent such rare injuries.

"It's as bad an injury as you can have," Dr. Paul McAfee, chief of spine surgery at St. Joseph Medical Center, said of Everett's case. "It's the same kind of thing Christopher Reeve had."

McAfee was referring to the actor, famous for his portrayal of Superman, who died in 2004, almost a decade after an equestrian accident left him paralyzed.

McAfee learned the details of Everett's condition from Dr. Andrew Cappuccino, the orthopedic surgeon who operated on the tight end. Now in private practice in Buffalo, Cappuccino spent a year training under McAfee at St. Joseph a decade ago. The two have consulted on Everett's case.

McAfee said Everett's chances for recovery were improved by the cutting-edge care he received immediately after the injury.

"It was about as fast as you could humanly treat a person," McAfee said.

Everett was injured trying to tackle the Denver Broncos' Domenik Hixon during the second-half kickoff at Ralph Wilson Stadium in Buffalo. After driving his helmet into Hixon's shoulder pad as the two collided head-on, Everett collapsed face-down and remained motionless, conscious but unable to move his arms or legs.

A rescue squad rushed him to a nearby hospital, and within 15 minutes of his arrival, Mc- Afee said, doctors were cooling his spinal cord using intravenous fluids.

They also administered anti-inflammatory medications and oxygen to help protect the nerve cells in Everett's damaged spinal cord, which carry messages from the brain to the rest of the body.

"The injury limits blood flow to the area, so the cells are starved of oxygen," McAfee said. "Cooling, steroids and giving oxygen prevent cell death."

MRI and CT images of Everett's cervical spine showed that the impact of his collision with Hixon had compressed the C-3 and C-4 vertebrae in Everett's neck, fracturing both vertebrae, damaging the soft cervical disc between them and crushing the front of his spinal cord, McAfee said.

Such injuries typically occur when a defensive player rams the top of his helmet into another player during a tackle, a technique known as "spearing." Such tackles often happen during a kickoff, when opposing players are running toward one another at top speed.

The impact travels through the helmet and skull into the neck, where it compresses the vertebrae.

"The vertebra actually explodes," McAfee said. "You can't make a helmet that will prevent such a neck injury if you want to allow a high degree of motion."

The neck rolls worn by some players are designed to prevent hyperextension of the neck, not the compression injuries that result from spearing, he said.

To prevent spinal injuries, high school leagues have banned spearing, and coaches and officials remove players from a game for tackling with their heads down. The practice brings a 15-yard penalty for unsportsmanlike conduct in high school, college and professional football.

High school coaches said they regularly train their players in correct tackling.

"No matter how busy we get with the X's and O's, we'll be cognizant of the safety aspect," said Roger Wrenn, head football coach at Polytechnic Institute. "Because I never want to be the guy who calls a player's mom and says, 'There's been an accident.'"

Brian Abbott, head football coach at Loyola Blakefield, said it can be difficult to rid players of the spearing habit.

"A kid's natural instinct is to duck his head when tackling," he said.

Abbott was a second-year head coach at Loyola in 2004 when Van Brooks Jr., a 16-year-old junior defensive back, was paralyzed when his head struck the knee of another player while he was making a tackle.

"I've never used Van's name during any tackling drill," Abbott said. "That's inappropriate. But [the injury] is definitely on these kids' minds.

"We do tackling drills every day. Your goal as a tackler is to be able to see what you hit. If a player puts himself in jeopardy, I take him out of the game and tell him, 'Lead with your head and you're not going to play.'"

Doctors said the ban on spearing has reduced the number of injuries in high school games but has had less impact at the college and professional levels.

"The fact of the matter is that football players are taught to use their helmet as a weapon," McAfee said.

Dr. Bill Howard, director of Union Memorial Sports Medicine, noted that NFL and college players are also heavier and faster than high school players.

"With all the contact between these huge men, and all the speed and weight that they have, it's actually remarkable that there aren't more of these injuries," he said.

When they do happen, he said, doctors try to operate as soon as possible to save as many spinal nerves as possible.

St. Joseph's McAfee said Cappuccino tried to treat Everett's injury during a four-hour operation by first relieving the pressure his damaged vertebrae and disc were putting on the spinal cord.

He then shored up Everett's spine using spinal fusion, aspects of which were pioneered at Johns Hopkins Hospital.

The technique involved removing Everett's ruptured cervical disc and replacing it with a bone graft that fused the two fractured vertebrae, bridging the damaged region of spine.

A plate and four screws were used to support the area, along with two small rods and four more screws.

The spinal injury puts Everett at risk of pneumonia and respiratory failure, and lying immobile puts him at risk of blood clots in his lungs and legs.

"He's definitely not out of the woods yet," McAfee said. "It's a critical type of injury. There are a whole host of possible severe medical complications."

There were encouraging signs, however. Before he was sedated, Everett could breathe on his own and reported having feeling throughout his body, a sign that some of his nerve connections were intact.

"If there's even a little bit of sensation," McAfee said, "there's a chance they will get mobility back."

Everett's leg muscles also appeared to have regained at least some of their former strength.

"He also got the best care," Mc- Afee said. "I would say that he would be able to walk again. Then again, you're talking about a big tight end. ... He's got a lot to support."

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