Multiple-level cervical spine trauma in children: Case report and literature review

Abstract

Spinal trauma is rare in children, but when it occurs, trauma of the cervical spine corresponds to 60%-80% of all cases. The most common causes of pediatric cervical spine injuries are automobile accidents, sports activities, and leisure-related accidents. Herein we report a surgically-treated case of cervical spine trauma with fractures of multiple vertebrae. A 12-year-old female victim of a high fall (from a tree) was admitted to the emergency room with neck pain and weakness in all the limbs. On examination, she was conscious, breathing spontaneously, with grade-4 tetraparesis, and preserved sphincter control. Cervical spine computed tomography (CT) revealed a burst fracture of the C4 body with retropulsion into the spinal cord and fractures of the C5 body and posterior elements of C2, C3, and C4. Cervical spine magnetic resonance imaging (MRI) revealed a hypersignal of the spinal cord from C3 to C6 in T2, indicating contusion. Because no signs of posterior spine instability (ligament lesions) were noted on MRI, we decided to perform a C3-C5 anterior arthrodesis with C4 corpectomy and autologous (iliac) graft placement. The patient had a good postoperative evolution. Furthermore, the patient had no motor deficit, but due to the other fractures in the spine, we chose to keep the cervical collar for 3 months and followed-up on an outpatient basis. Although spinal trauma is less frequent in children than in adults, children can have severe cervical spine injuries (multiple fractures with spinal contusion), and then surgery plays a key role in stabilizing the spine and decompressing the spinal cord to avoid sequelae.

Keywords: Children; Fracture; Spinal cord; Trauma.

Fig 1

a- Cervical spine radiography with fracture of the posterior elements C2, C3 and C4 (white arrows); b- Computed Tomography (CT) scan: bony window with C4 and C5 body fracture (black arrows).

Fig. 2

Sagittal T2-weighted magnetic resonance imaging (MRI) showing spinal cord contusion (white arrows).

Fig. 3

C4 anterior cervical corpectomy and fusion (C3-5) with iliac crest strut graft.