Introduction: The aim of this study was to review unique surgical and post-operative challenges encountered when treating traumatic spine fracture/dislocation and spinal cord injury in newborn infants.
Methods: We report a remarkable case of an infant who suffered a birth-related trauma resulting in C4/5 spondyloptosis and severe spinal cord compression (C5 quadriplegia) secondary to complete ligamentous disruption and C5 burst fracture. The child was treated successfully at the University of Wisconsin in 2012 with 17 months follow-up.
Results: A newborn infant presented to our institution with quadriplegia secondary to C4/5 spondyloptosis. The fracture resulted in complete disarticulation and severe spinal cord compression. Using the microscope and micro-instruments, the infant underwent anterior C4/5 discectomy followed by a C2-7 posterior fusion with autologous rib. The rib was sewn to the lamina using silk suture. The alignment remained suboptimal following the posterior fusion, therefore a C5 corpectomy was performed using rib autograft and an absorbable anterior plate (C4-6). The corpectomy was performed using a 1mm diamond burr and an INKA rongeur from the otolaryngology ear pan. The child had immediate improvement in upper and lower extremity function. He was maintained in a custom Minerva for 6 months. With extensive physical and occupational therapy, he is now standing and attempting to crawl with mild residual weakness in hand intrinsics. His cognitive development is normal. CT scans demonstrate complete anterior and posterior fusion. He has no difficulty with swallowing and his tracheostomy has been successfully removed for 6 months.
Conclusions: We report the youngest child to undergo surgical fixation for traumatic cervical spondyloptosis. While the surgical principles of decompression and fusion are standard, the means of achieving success in infants requires a unique approach to the surgical planning and instruments, autologous grafts, bracing and post-operative management.
Patient Care: Conceptually, the goals of surgery are no different between a child or an adult: decompression, realignment and fusion. However, the techniques and tools available to perform surgery in an infant are significantly different. Making surgeons aware of the technical challenges of spinal fusion in newborns will allow surgeons to "think outside the box" when faced with a young child with gross cervical instability.
Learning Objectives: By the conclusion of this session, participants should be able to:
1. Appreciate the severity of potential birth related cervical spine injuries
2. Understand how the biomechanics of the neonatal spine will affect surgical planning and instrumentation
3. Anticipate post-operative management and bracing