Three Column Cervical Fracture-Dislocation in a 3-Year-Old Boy

Area of Science:

• Pediatric neurosurgery
• Spinal cord injury research
• Traumatology

Background:

• Complete traumatic cervical fracture-dislocation with spinal cord transection is exceptionally rare in children.
• Existing literature lacks evidence-based guidelines for managing such severe pediatric spinal cord injuries.
• This case addresses a critical knowledge gap in pediatric spinal trauma management.

Observation:

• A 3-year-old child presented with a complete C6 spinal cord injury (ASIA A) due to traumatic cervical fracture-dislocation.
• The patient sustained concurrent injuries to the liver, spleen, bowel, and abdominal aorta.
• Intraoperative monitoring revealed motor evoked potential signals below the injury level, suggesting preserved neural pathways.

Findings:

• The patient underwent halo placement for reduction, followed by open reduction, internal fixation, and posterior segmental instrumented fusion.
• Postoperative follow-up showed no improvement in leg function but demonstrated recovery of upper extremity function.
• Electrographic evidence of sub-lesional function correlated with observed upper extremity motor improvements.

Implications:

• This case demonstrates the feasibility of surgical intervention for complete pediatric cervical spinal cord transection.
• Early surgical stabilization and fusion may be beneficial, even in cases with apparent complete injury.
• The findings suggest potential for neurological recovery below the clinical injury level in pediatric patients, emphasizing the importance of intraoperative neuromonitoring.