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Posterior cervical spinal fusion in a 3-week-old infant with a severe subaxial distraction injury
Christopher M Holland1, Meysam A Kebriaei2, David M Wrubel1,3
1Department of Neurosurgery, Emory University School of Medicine, Atlanta, Georgia;
Insights
This case study details the first spinal fusion in an infant under one month old for a severe cervical fracture dislocation. The procedure successfully stabilized the spine, showing fusion and improved motor function, despite residual neurological deficits.
Area of Science:
- Pediatric Neurosurgery
- Spinal Surgery
- Neonatal Trauma
Background:
- Neonatal spinal injuries present unique assessment and surgical stabilization challenges.
- Subaxial cervical fracture dislocations in neonates are rare and complex injuries.
- Nonaccidental trauma is a critical consideration in infant spinal injuries.
Observation:
- A 3-week-old infant sustained a severe C5-C6 subaxial cervical fracture dislocation with spinal cord injury due to nonaccidental trauma.
- Imaging revealed significant distraction and near-complete spinal cord transection, leading to quadriplegia.
- The patient underwent open surgical reduction and posterior fusion using autograft and bone morphogenetic protein-2.
Findings:
- Postoperative imaging confirmed progressive bony fusion at 2 months, with maintained cervical alignment at 2 years.
- Clinical examination showed improvement to ASIA C motor classification.
- Long-term follow-up revealed stable fusion, but persistent lower extremity flaccidity and C5 nerve root avulsions.
Implications:
- This case is the first documented spinal fusion in an infant under one month of age.
- It highlights the diagnostic and technical considerations for surgical fusion in extremely young patients.
- The study underscores the potential for successful spinal stabilization and functional recovery in severe neonatal spinal cord injuries.
Abstract:
Unstable spinal injuries in the neonate pose particular challenges in the clinical and radiographic assessment as well as the surgical stabilization of the spine. In this report, the authors present the unfortunate case of a 3-week-old infant who suffered a severe subaxial cervical fracture dislocation with spinal cord injury that occurred as a result of nonaccidental trauma. Imaging demonstrated severe distraction at C5-6 and near-complete spinal cord transection resulting in quadri-paresis. Open surgical reduction was performed with noninstrumented posterior fusion augmented with split rib autograft and recombinant human bone morphogenetic protein-2. Postoperative imaging demonstrated progressive bony fusion at 2 months, and clinical examination findings progressed to a motor examination classification of ASIA C. At 2 years, the fusion mass is stable and cervical alignment is maintained. The patient remains flaccid in the bilateral lower extremities, but has movement with some dexterity in both hands. Follow-up MRI shows severe spinal cord injury with evidence of bilateral C-5 nerve root avulsions. This case represents the first report of spinal fusion in an infant of less than 1 month of age. Given the extreme young age of the patient, the diagnostic challenges as well as the mechanical and technical considerations of surgical fusion are discussed.
