Spinal cord transection distal to a cervical fracture-dislocation in a young child: Mechanism of injury

Abstract

The excessive mobility of the cervical spine in a young child is the most important factor in determining the risk and pattern of spinal cord injury. On the one hand, extra mobility protects the spinal cord by dispersing deformational forces over multiple levels, which contributes to the overall low incidence of spinal cord injury in this population. On the other hand, as the structural components of the cervical spinal column aptly resist the deformational forces, the spinal cord cannot withstand such forces nearly as well. Thus, if a spinal cord injury does occur, it is often severe and more likely involves the upper cervical spine. Once a child reaches the age of 10 years, the spine has matured to the point that it assumes a more adult-type anatomy and biomechanical profile, and thus, the injuries in older children are more similar to those found in adults.Before the widespread use of magnetic resonance (MR) imaging, it was not uncommon for children to present with clinical evidence of a spinal cord injury with normal radiographic information. This phenomenon was termed spinal cord injury without radiographic abnormality (SCIWORA) and was directly attributable to the hyperflexibility of the spine. Spinal cord transection represents the most extreme example of this imbalance between the inherent elasticity of the pediatric spine and the fragility of the spinal cord. We present the case of a young child who not only suffered such a rare and devastating injury but also received other injuries, including a remote cervical fracture that caused a secondary site of spinal cord injury, that provide insight into the extreme forces that were involved.