Non-Contiguous Cervical and Thoracic Spinal Cord Injuries After Severe Polytrauma: A Case Report

Background and Clinical Significance: Non-contiguous traumatic spinal cord injury (SCI) can be difficult to recognise and classify in severe polytrauma, especially when traumatic brain injury (TBI) and limb injuries limit neurological examination. Case Presentation: A 17-year-old male was involved in a motorcycle accident resulting in severe polytrauma with TBI. Brain magnetic resonance imaging (MRI) showed a grade III diffuse axonal injury. Trauma computed tomography (CT) identified C2 and T3-T5 vertebral fractures. Spinal MRI revealed a non-haemorrhagic C3-C6 contusive myelopathy, a T4 spinal cord contusion, and a thoracic posterior epidural haematoma. He underwent posterior T2-T7 fixation. Acute neurological examination was limited by impaired consciousness and associated injuries. At four months, the International Standards for Neurological Classification of Spinal Cord Injury (ISNCSCI) assessment showed a neurological level of C2, and a total motor score of 55. Electrodiagnostic testing showed active bilateral C5-T1 denervation. At seven months and one year, the total motor score increased to 63 and 82, respectively, accompanied by substantial functional improvement. Conclusions: In severe polytrauma with TBI, non-contiguous SCI should be considered when neurological examination is unreliable. In non-contiguous SCI, clinical assessment should integrate neurological examination, including quantitative motor and sensory scores, with imaging and neurophysiological studies, cognitive status, associated injuries, and functional outcomes.