title: Posterior cervical spinal fusion in a 3-week-old infant with a severe subaxial distraction injury.
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.
authors.affiliation: Department of Neurosurgery, Emory University School of Medicine, Atlanta, Georgia;
authors.forename: Christopher M
authors.initials: CM
authors.lastname: Holland
authors.affiliation: Children's Hospitals and Clinics of Minnesota, St. Paul, Minnesota; and.
authors.forename: Meysam A
authors.initials: MA
authors.lastname: Kebriaei
authors.affiliation: Department of Neurosurgery, Emory University School of Medicine, Atlanta, Georgia;|Pediatric Neurosurgical Associates, Children's Healthcare of Atlanta, Georgia.
authors.forename: David M
authors.initials: DM
authors.lastname: Wrubel
mesh_terms: D002574:Cervical Vertebrae / Q000601:surgery*; D002649:Child Abuse; D005260:Female; D006801:Humans; D007231:Infant, Newborn; D004204:Joint Dislocations / Q000601:surgery*; D008279:Magnetic Resonance Imaging; D013119:Spinal Cord Injuries / Q000209:etiology; D016103:Spinal Fractures / Q000150:complications / Q000601:surgery*; D013123:Spinal Fusion / Q000379:methods*; D016896:Treatment Outcome
keywords: ASIA = American Spinal Injury Association; BMP = bone morphogenetic protein; cervical spine injury; neonate; rhBMP = recombinant human BMP; spinal cord injury; spinal fusion; spine