Successful surgical repair and recovery in a 2-week-old infant after birth-related cervical fracture dislocation

Abstract

<jats:p>Cervical spine injuries are the most common spine injuries in the pediatric population. The authors present the youngest known patient who underwent cervical spine fusion to repair birth trauma–induced cervical fracture dislocation, resulting in spondyloptosis and spinal cord injury. A 2-week-old boy was found to have spondyloptosis and spinal cord injury after concerns arose from reduced movement of the extremities. The patient’s birth was complicated by undiagnosed abdominal dystocia, which led to cervical distraction injury. At 15 days of age, the boy underwent successful C-5 corpectomy, with anterior C4–6 and posterior C2–7 arthrodesis, using an autologous rib graft for a C-5 fracture dislocation. MRI performed 2 weeks postoperatively revealed significant improvement in the alignment of the spinal canal. The patient was discharged from the hospital in a custom Minerva brace and underwent close follow-up in addition to occupational therapy and physical therapy. At the latest follow-up 4.5 years later, the patient was able to walk and ride a tricycle by himself. The authors describe the patient’s surgery and the challenges faced in achieving successful repair and cervical spine stabilization in such a young patient. The authors suggest that significant neurological recovery after spinal cord injury in infants is possible with appropriate, timely, and interdisciplinary management.</jats:p>

Management of perinatal cervical spine injury using custom-fabricated external orthoses: design considerations, narrative literature review, and experience from the Hospital for Sick Children. Illustrative cases

“…Our narrative literature review identified 11 studies reporting 19 cases of perinatal cervical SCI (Table 3). 1,2,4,5,[12][13][14][15][16][17][18] This review corroborated previous risk factors of breech position, shoulder dystocia, vacuum/forceps assistance, and fetal macrosomia for perinatal cervical SCI. In our series, we identified forceps and vacuum assistance but did not report either macrosomia or fetal presentation risk factors.…”

“…3 Based on existing literature, the prognosis of birth-related SCI in neonates is poor, with a high mortality rate and long-term neurological morbidity among surviving patients. 1,4,5 SCI in the pediatric population can be classified based on the radiographic appearance: fracture, fracture with subluxation, subluxation alone, and SCI without radiographic abnormality. 6 Treatment is centered around providing appropriate immobilization, reduction, and stabilization in order to achieve spinal stability while mitigating permanent neurological deficits and long-term sequelae, including joint contractures, fractures, and scoliosis.…”

Management of Neglected Post-traumatic C4/C5 Spondyloptosis in a Low Resource Setting: a Review of Literature and Case Study.

“…The time of presentation from trauma ranges from a few hours to eight years. 2,3,9,13,14 Interestingly, our patient and those reported by Gascol et al 8 , Sakta et al 13 , and a case reported by Padwal et al 15 , all presented eight months following trauma.…”

“…However, unusual mechanisms such as vaginal delivery, intubation, spinal massage or manipulation, and indoor slippage and fall, as in our index case, have been reported. 9,[11][12][13] Available data show that the C7-T1 level was the most affected segment. 3,14 Six cases of C4-C5 level involvement, similar to our index case, have been reported and are summarized in Table 1.…”

Traumatic cervical spine spondyloptosis

“…TCS is caused in nearly half of the cases by road traffic accidents; in second row, falls are responsible of more than third of reviewed cases, mostly from small altitudes but with bad reception. Other causes of TCS way uncommon include diving accidents and iatrogenic traumatisms; in fact, when the two cases of obstetrical TCS seem to have no particular precaution on childbirth than other spinal traumas,[ 5 6 ] others are predictable. Kim et al .…”