Pediatric Traumatic Cervical Distraction Injury: A Case Report

TL;DR

A one-year-old child with a severe cervical spinal cord injury from trauma underwent surgical treatment, but her condition did not improve over time.

Contribution

This case report provides insights into the surgical management and outcomes of a rare cervical distraction injury in a very young pediatric patient.

Findings

Surgical intervention included a Nespron tape and bone graft at C6/7, resulting in complete bone fusion six months post-surgery.

Despite surgical treatment, the patient remained tetraplegic with no functional improvement one year and six months after the injury.

Radiographs showed no growth disturbances in the child despite residual spinal alignment abnormalities.

Abstract

Spinal cord injury due to trauma is rare in children. We report our experience with the surgical treatment of a cervical spinal cord injury in a one-year-old child with quadriplegia due to traffic trauma. The patient was a girl aged one year and five months. Physical examination findings were quadriplegia and loss of consciousness. Plain computed tomography (CT) of the cervical spine showed a vertical distraction injury of C6/7, and magnetic resonance imaging (MRI) showed spinal cord injuries of C1/2 and C6/7. Based on these findings, a diagnosis of C1/2 and C6/7 spinal cord injury (Frankel A) was made. The patient’s state of consciousness did not change during the first week after injury; she was managed systemically with a ventilator. On the 10th day after the injury, her consciousness improved, and she was placed in a pediatric halo vest for weaning. However, as the alignment worsened, we operated. A 5 cm posterior incision was made at the median of C5/6/7. Only the spinous process was deployed, a Nespron tape (Alfresa Pharma Corporation, Osaka, Japan) was wrapped between C5/6 and C6/7, and an autologous iliac bone graft was placed at the C6/7 bilateral facet joint. Six months after surgery, bone fusion was complete. At one year and six months postoperatively, tetraplegia had not improved. Radiographs showed no growth disturbances despite residual alignment abnormalities.

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