Revolutionary surgical procedure for a type of decapitation

Nov 6 2007

A revolutionary surgical procedure by a professor of neurosurgery at the University of Mississippi Medical Center has helped restore almost complete function to a patient who suffered a virtual decapitation.

Mark Barnett of Ridgeland had been physically active all of his life. He grew up playing a variety of team sports, enjoyed hunting and fishing, worked summers as a fly-fishing and hiking guide on a ranch in Colorado, and became so proficient at shooting sporting clay targets that he achieved a national ranking in the sport when he was 18.

One of his favorite activities was cycling. Starting on Independence Day of 2006, the 24-year-old would routinely leave his Ridgeland home and bike several hours each day on the Natchez Trace.

Barnett was in great shape physically and his career was on a fast track. He was a rising star of a regional accounting firm. He had begun to study for the CPA exam. He had just received a promotion and already was up for another one as he pedaled his way home on the Trace last September 6.

The majority of his workout was over. He was less than three miles from his house. But in a flash, everything in Barnett's life changed.

He doesn't remember feeling the impact of the vehicle that crashed into him near the Rice Road interchange of the Natchez Trace that evening. He was told that he went straight through the automobile's windshield; that when his body finally rolled to a stop on the side of the road, many motorists thought he was a deer that had been run over.

What Barnett does remember is waking up in an intensive care bed at the University of Mississippi Medical Center with a tube down his throat and an inability to move his right arm or either leg.

“I really had no clue about the extent of my injuries until five or six days after the accident,” Barnett recalled. “I was paralyzed. I could only barely move my left arm. I remember that there was a question of whether I would ever be able to walk again.”

The impact of the accident had been severe enough to dislocate the joint between Barnett's skull and his cervical spine. The injury was not necessarily uncommon in many similar traumatic situations. What made it peculiar in Barnett's case was that the patient was still alive.

“This is a connection not just between the skull and the spine, but between the brain and the spinal cord,” explained Dr. H. Louis Harkey, professor of neurosurgery at UMC and the man whom Barnett credits with having saved his way of life. “The impact was just hard enough to cause the injury, yet not cause a complete spinal cord injury.

“It takes a great deal of force to dislocate that joint. Because of the neurological structure in that region, most people who suffer that kind of injury die at the scene.”

In the strictest definition of the term, Barnett had suffered a decapitation. And it was Harkey's task to determine the best way to repair the injury.

"If you have a spinal cord injury, you can lose some or all neurological function below the level of the injury,” Harkey said. “People who are paralyzed from the neck down have injuries where Mark's were. When you are paralyzed that high up, you lose your ability to breathe on your own. That's what happens to so many who suffer this kind of injury.”

Barnett was initially immobilized in a collar and intubated immediately upon arrival at the Medical Center. His neurologic findings lead to X-rays that revealed the dislocation, and Harkey quickly developed a plan to stabilize his craniovertibular junction.

Harkey decided to perform a bony fusion, or arthrodesis, on an individual who was truly lucky to be alive.

The procedure involved anchoring a Y-shaped plate to a keel of bone in the back of the skull, then screwing it down into the spine, rigidly connecting Barnett's skull to his backbone. Most occipitocervical stabilizations involve attaching the skull to somewhere lower in the spine because it is much easier to do and because the first cervical vertebra is typically unsuitable since it is usually involved in the process causing the instability. But Barnett's situation was far from ordinary.

Had Harkey connected Barnett's skull to the second cervical vertebrate, Barnett would have lost considerable range of motion in his neck. But Barnett was healthy, young and active, and most importantly, the dislocated joint was perfectly normal otherwise.

Using a special plate that he and a team of surgeons had patented a few years earlier, Harkey was able to anchor Barnett's skull to his first cervical vertebrae. Were the surgery to be successful, Barnett's bone structure would recover completely. But surgical success didn't guarantee he would ever recover neurological function.

“I said from Day One after the surgery, ‘I'm going to get all of my function back,'” Barnett said. “I'm a real determined person. I kid Dr. Harkey when I say this is probably the first time being hard-headed really paid off.”

Barnett began an agonizing physical therapy routine each day to regain what the accident had cost him. As his upper extremity function began to return, he put together a list of abilities he wanted to recover. “Speak.” “Use right hand.” “Walk.” “Regain normal vision.” Some abilities returned more quickly than others.

“There was always that doubt lingering around me,” Barnett said. “The therapists were great, but when they asked me to do certain things, like try to write with my left hand, it was a way of saying that I might not regain function in my right hand. I would disregard those requests. I was determined to get back to my normal level of function.”

His rugged determination paid off over the next few months of grueling rehab. As his right hand regained much of its strength, he was able to check off each item on his list, until only one thing remained: “regain normal vision.”

“After I was able to walk, my eyes became my biggest concern,” he said. “No one knew whether they would come back or not. I felt that was the only thing that was out of my control; everything else, I felt I could take care of, no matter what. But if my vision didn't come back, the surgery and all the rehab were for nothing.”

Every day, Barnett would measure just how far he could see before the double-vision kicked in. For months, he couldn't see clearly for more than six inches, but gradually that distance increased to a couple of feet, then six feet. Then one morning, he got a signal that he had turned the corner on his recovery.

“One day I woke up and I could see all the way across the street,” he said. “By that time, I had gone back to duck hunting with an eye patch. But to me, as competitive as I am, my vision had to be perfect. So the day I was able to see without double-vision was an important one for me.”

Less than a year after the accident that left him lucky to be alive, Barnett shows few clues to his harrowing ordeal. His voice is a bit raspy – the result of a paralyzed vocal chord – the range of motion in his neck is not quite what it was and he is still trying to regain normal strength in his right arm. But he's now able to work full-time, exercise and hunt, and once again he's studying to take the CPA exam he missed because of his injury.

And true to his conviction, as soon as Harkey gives him permission, he's ready to climb back onto a bicycle.

“I don't look at myself as being any more susceptible to injury than I was before,” Barnett said. “It's about living. I might be a little more careful now, but I'm going to do what I've always done.”

Barnett's injury hit close to home for the man most responsible for helping him return to his normal daily routine. An avid cyclist himself, Harkey has ridden his bike many times down the same stretch of the Natchez Trace that almost cost Barnett his life.

"Mark was doing what I love to do,” Harkey said. “His was such an exceptional case because not only is he a physically healthy young man, he is psychologically healthy and strong. It was never certain he would regain the level of function that he did. He had the drive to get better and the psychological strength to cope with his deficits.

“This sort of case stands out to me because so many of my neurologically impaired trauma patients don't get the recovery of function (that Barnett has) and live the rest of their lives with paralysis. It's just very rewarding to see somebody get this kind of recovery.”