Decapitated But Not Dead: Saving Judy's Neck - NewsChannel5.com | Nashville News, Weather & Sports

Decapitated But Not Dead: Saving Judy's Neck

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NASHVILLE, Tenn. (Ivanhoe Newswire) – A woman lost her head in a car accident and she's still alive.

Judy Kerns is a medical miracle.  A car accident left the bone in Judy's neck literally crumbled.

"My neck, I couldn't get my neck back up," Judy Kerns told Ivanhoe.

Judy was decapitated internally. Her head had fallen off her spine.

"It was just like somebody was sticking knives in me, and my whole body would just freeze up in pain," Judy said.

She couldn't lift her head to eat and dropped to 98 pounds. She also developed sores under her neck that became infected, but doctor after doctor told Judy they didn't know how to fix her head.

"I was scared. I guess I was in so much pain. I just wanted it all over," Judy said.

Then she met Vanderbilt surgeon Matthew McGirt who said he'd try a risky, but potentially lifesaving procedure.

"We knew without surgery, she would likely die," Matthew McGirt, M.D., a spine surgeon at Vanderbilt University Medical Center, said.

For two weeks doctors worked to get Judy healthy again. That meant nutrition through a feeding tube and treating her infected sores. Then came the week-long surgery.

"This was the first time I had to rebuild someone's entire cervical spine. The real trick was doing it without paralyzing her," Dr. McGirt said.

Doctors created a titanium cage to replace the front of Judy's spine. They also ran three long rods down the back of her neck to hold her head up. The entire surgery took 30 hours. After three days, Judy was walking. Now, she can't move her head or neck, but she's able to eat, walk outside  and most importantly play with her grandkids.

Judy has to be extremely careful not to hit the metal pieces in her neck. Just one bad fall could paralyze or even kill her. She can't run, jump or lift over five pounds.

RESEARCH SUMMARY

CERVICAL SPINE SURGERY: The goal of cervical spine surgery is to relieve pain, numbness, tingling and weakness, restore nerve function and stop or prevent abnormal motion in the spine. The surgeon does this by removing a disc or a bone and fusing the vertebrae together with a bone graft either in front of or behind the spine. The bone graft may be one of two types: an auto graft, bone taken from your body, or an allograft, bone from a bone bank. Sometimes metal plates, screws or wires are also used to further stabilize the spine. These techniques are called instrumentation. When the vertebrae have been surgically stabilized, abnormal motion is stopped and function is restored to thespinalnerves.(www.spineuniverse.com)

INTERNAL DECAPITATION: Internal decapitation occurs when the ligaments connecting the skull to the spine are severed due to severe head trauma. Typically, the head is only held in place by the skin and spinal cord. Any movement could cause injury to the spinal cord and result in devastating neurological consequences or even death. Internal decapitation is five-times more common in children than it is in adults. (SOURCE: bnaneuro.net )

SURGERY: In order to fix internal decapitation, a neurologist may implant a titanium loop in the neck/head to reattach the base of the skull to the spine. A piece of the patient's rib may be removed and used to hold the rod in place. (SOURCE: bnaneuro.net )

SURGERY AFTERMATH: Although most patients who endure severe head trauma and internal decapitation have severe neurological damage, some will have a full recovery with no brain damage or neurological issues. In some cases, the patient will have full neurological function but will lack the ability to move the head in any direction. The surgery itself is very high risk and could result in paralysis, neurological damage or even death. After the surgery, patients have to be careful with their movement. One hard hit or fall could end in paralysis or death.

INTERVIEW

Mathew McGirt, Assistant Professor of Neurosurgery and Orthopedic Surgery, Vanderbilt University Medical Center discusses the reconstruction of a woman's spine in a one of a kind surgery.

Dr. McGirt: Judy Kurns story really is an amazing one, really a courageous one and a very challenging case right off the bat in my career.

What happened?

Dr. McGirt: Basically I got a phone call from the emergency room when I was on call, my residents gave me a call and the plastic surgery team gave me a call and the infectious disease team gave me a call and the wound care nurse all gave me a call that day. And clearly I knew something was going on, a complicated problem. Little did I know when I walked in to see Mrs. Kurns that day the magnitude of her disease.

What did you see when you saw her?

Dr. McGirt: Well I saw a very lovely woman who was in distress and really desperate, who was very sick, had lost thirty-five pounds over the last two months. Was unable to hold her head up, unable to open her mouth and unable to eat, had developed an infected ulcer under her chin. Her head literally had fallen off her spine.

How do you live when that happens?

Dr. McGirt: Well you don't it's very hard I mean I think she was on way to potentially dying over the next couple of months. I think she knew that and she was desperate to get some help.

So before you had a chance to fix her main problem you had to fix a lot of other things.

Dr. McGirt: That was the challenge is that she had a multitude of problems. In order to even begin to think about surgically correcting this very complicated problem in her neck she had to clear an infection. But in order to clear the infection she needed the pressure taken off her neck which means she needed her head to be held up and she needed nutrition, she needed IV antibiotics and she needed a complicated plastic surgery closure of this infected wound.

And all the way through this she could have become paralyzed because of the way her head was.

Dr. McGirt: Well that's right and the trick really was not only how to get her head back on and rebuild her spine. Just the feasibility of doing that and creating a construct, an artificial neck if you will, the real trick was doing it without paralyzing her.

How does your head just fall off?

Dr. McGirt: Well she had a very complicated situation. She was very unfortunate had been in an accident, had some advanced degeneration of the spine. And whether it be genetics or stress over an active lifestyle her neck really had sort of aged and broken down and accelerated away. And she had some surgeons who did a very good job with treating some of her early progression with this disease. But the fact of matter is her disease process in her neck was advancing rapidly and really had overcome the surgical procedures that she had.

How did you put her head back on?

Dr. McGirt: Well the first thing was the great thing about being at Vanderbilt is we really have world-class physicians and teams across the board. So we involved the infectious disease doctors right off the bat and plastic surgeons, involved my head and neck colleague Jim Netterville and we admitted her obviously. And we had two major issues up front. She needed nutrition and she needed to put on some weight, she had lost thirty-five pounds because she couldn't open her mouth. The second one was we had to clear her infection. We could not rebuild and put metal in her neck if she had any signs of an active infection. So we knew this was going to be a one, two month process.

Was she in the ICU this whole time?

Dr. McGirt: We had to admit her to the ICU and the first thing we had to do was create some room here between her neck, her jaw and her chest so that, one the ulcer could even begin to heal and take the pressure off, two; the plastic surgeons could fix that infection and three; the antibiotics could work. So what we did is we had to admit her and we had to put pins in her skull and we had to slowly hang weights over weeks. And this was a very painful process for Judy and really speaks to her courageous story and her ability to really take this on.

What do you mean hang weights?

Dr. McGirt: So it's called traction, and we had to closely follow her neurological exam and shoot x-rays. And we laid her down we put pins in her skull and then we actually would simply increase the amount of weights that would pull her head slowly off her chest. The whole time here we need to make sure we're not impinging or hurting the spinal cord. This was a two-week process.

Where did her neck start out at, what did she look like when she came to you?

Dr. McGirt: When she came in, I have a model here. This is a recreation of how her neck was. This shows you, this is her jaw down her and this is her neck bent over and you can see it from this side her jawbone was all the way down. So she came in with the complete inability to hold her head up. I was going to go to the x-ray and show you here. So what we did was once we were able to get her neck up a bit we were able then to lock her in a halo vest. So once we were able to create enough room we were able to then hold her position in a rigid halo vest so that the plastic surgeons could go in and fix the infected ulcer. And she sat like that getting nutrition through a feeding tube and intravenous antibiotics for about two and a half weeks before we knew she could safely undergo the massive rebuilding of her neck.

This is the first surgery you've ever done like this.

Dr. McGirt: Yes this was, essentially this was my fourth week here at Vanderbilt out of fellowship training and was a big task to take on. But we knew without surgery she would likely die and not be able to eat. So I explained to Judy that the risks were very high. That the greatest risk to her was paralysis and we found a way to take her neck from a ninety degree angle to an upright angle given all that had broken down in her neck that the chance of her being paralyzed was very high. But given the alternative of not being able to eat and the eventual likelihood of eventual mortality Judy, her family as well as our team felt that the only option was to try to rebuild her neck.

So you had to come up with how to rebuild it from scratch?

Dr. McGirt: We did and I partnered with an excellent company industry DePuy Spine who met with me their team met with me the local distributorship met with me and for about two weeks we planned out how we were going to do this. And we looked at the images the CAT scans and we with the help of DePuy built specialized implants that could meet her needs that could give her a sustainable titanium neck.

Could you show us?

Dr. McGirt: This is what we did and this was a model that we put together by myself and the guys at DePuy. The first thing we had to do we had to remove her entire spine. This is the top of her rib cage where her thoracic area starts and this is as you can see the base of her skull. We had to take out the entire mobile segment of her spine. This is five vertable segments. And then we, remember it was really completely falling over, in addition to straightening her up we had to release all of the bone in order to get her neck to stand up, one. Two, we had to have a construct here and this is a large titanium cage if you will and we had to get this fit in the right alignment so that it was solid. In the back we had to do similar things we had we had to remove the bone, we had to get her straightened up, and then we had to link in screws that go in to the spine and surround the spinal cord with out hitting it that would extend up to the base of the skull. And we had to us three rod construct here because usually we rely on bone to heal and fuse and become solid she had such a large gap basically, an entire eight centimeters between her skull and her chest it's almost impossible to get a bony fusion across that level. So we knew that she would have to live her next thirty years relying on the hardware. That's what would hold her head on. So we ran a third rod that was made out of special metal if you will that was extremely rigid and would not break. So that's why we used this three-rod system. And this really is what is holding Judy's head together here.

Can she move her head now?

Dr. McGirt: She cannot and that's the other thing we needed to make sure we left her in perfect alignment because this is how she will look. So she can bend at the waist, rotate at the waist but as far as her head goes she can't nod, she can't rotate upon her shoulders she is completely rigid here.

So this can hopefully last for the rest of her life?

Dr. McGirt: Hopefully this will be stable and last.

How many hours of surgery, how many days and how long before she can stand up and things like that?

Dr. McGirt: Judy was in the hospital about four and a half weeks. The first two and a half weeks were in traction that is with weights slowly pulling her head up and straighten her out, getting IV antibiotics, getting nutrition and healing. Then came the surgical part, it was one week of surgery. We took her and did the first of three stages on a Monday we came in from the back, removed all the bone, removed all the prior screws that were there. She stayed intubated in ICU, she came back on a Wednesday and we came through from the front and we did the front part. We removed all the front bone reconstructed the front, which at each stage straightened her out a little bit more. The third day brought her back for the final and last stage in the back again of her neck.

What day was that?

Dr. McGirt: That was Thursday the next morning. And that's when we finalized her alignment, put the final screws in and then used my plastic surgery colleagues to swing apart her latissimus muscle, the muscle in her back and swing up to her neck to reconstruct her neck muscles around it. She had such a small neck, had lost so much weight we knew that there was a risk that all this metal in her neck, her artificial neck would erode in her spine. So we had to swing up and recreate some back muscles in to her neck so that she would have really a normal, again normally aligned bony spine as well as a muscular spine.

So all the muscles in her neck were basically gone?

Dr. McGirt: They were infected they were diseased they were injured.

How long did she stay like that?

Dr. McGirt: She was like this for about three and a half weeks before surgery. And she couldn't open her mouth she couldn't eat and that's why she got so poor off. She was infected and that's when she showed up to us. All in all I mean I think she underwent about thirty hours of surgery in order to rebuild her neck.

When was the first time that you knew that it was a success?

Dr. McGirt: Well after each of the stages. Stage one on Monday, stage two on Wednesday, stage three on Thursday we never knew until we woke her up and got her to move whether or not her spinal cord tolerated. So each day was a victory, so every night when we finished one of the three surgeries we all waited to see her wake up, we all waited to see her wiggle her toes and move her fingers, move her arms and determined that okay, we made it through one third of the battle. When we really knew was when we exubated her Friday after twelve hours after the last surgery that she was able to move her arms her legs, talk to us that what we deemed a success we had done which was rebuild her in the right position without paralyzing her.

You said she was standing up three days after surgery?

Dr. McGirt: So we got her out of bed Sunday and we had finished Thursday night. So we exibated her Friday evening the next day twenty-four hours out. And then Saturday she was recovering in the ICU and then she was walking Sunday. And we knew her spinal cord function was perfect and that we at that point felt that she was going to have a normal quality of life again.

Was that an amazing moment?

Dr. McGirt: It was, it was a great moment for Judy. I mean the courage that she had to go through, four weeks of very painful treatment it was amazing. So it was very satisfying for everyone involved, with the surgeons, the ENT surgeons, my team.

Did she say anything when she sat up?

Dr. McGirt: She didn't have to. I mean she was tearful, she was happy, she was scared that she would be paralyzed. When it was clear to her that she was not her emotions and her actions said it all and we were all very happy for her.

Do you think there are more people who are going to benefit, this was your first ever right?

Dr. McGirt: Yes, this was the first time that I had to rebuild someone's entire cervical spine, the part of the spine in the neck. We do variations of this at one or two levels not five levels and not with the extent of disease that she had.

So do you think there are more people out there?

Dr. McGirt: There are, I think that there are a number of people out there who live in communities that have very, very advanced problems. That may not be able to get the access or the care that they need who we or other teams like ours here at Vanderbilt may be able to help.

FOR MORE INFORMATION, PLEASE CONTACT:

Craig Boerner, National News Director
Vanderbilt University Medical Center
Nashville, TN
(615) 322-4747
Craig.boerner@vanderbilt.edu

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