Management of perinatal cervical spine injury using custom-fabricated external orthoses: design considerations, narrative literature review, and experience from the Hospital for Sick Children. Illustrative cases

Abstract

Background: Cervical spine injuries in neonates are rare and no guidelines are available to inform management. The most common etiology of neonatal cervical injury is birth-related trauma. Management strategies that are routine in older children and adults are not feasible due to the unique anatomy of neonates.

Observations: Here, the authors present 3 cases of neonatal cervical spinal injury due to confirmed or suspected birth trauma, 2 of whom presented immediately after birth, while the other was diagnosed at 7 weeks of age. One child presented with neurological deficits due to spinal cord injury, while another had an underlying predisposition to bony injury, infantile malignant osteopetrosis. The children were treated with a custom-designed and manufactured full-body external orthoses with good clinical and radiographic outcomes. A narrative literature review further supplements this case series and highlights risk factors and the spectrum of birth-related spinal injuries reported to date.

Lessons: The current report highlights the importance of recognizing the rare occurrence of cervical spinal injury in newborns and provides pragmatic recommendations for management of these injuries. Custom orthoses provide an alternate option for neonates who cannot be fitted in halo vests and who would outgrow traditional casts.

Keywords: cervical spine injury; neonate; orthoses.

FIG. 1.

Custom neonate-sized cervical-thoraco-lumbo-sacral orthoses. Orthotics are designed as outlined with considerations for stability, age, and expected length of wear.

FIG. 2.

Case 1. Short tau inversion recovery (STIR) MRI (A) demonstrating signal suggestive of ligamentous injury. Initial radiograph (B) demonstrating no fractures and stable alignment. Six-month radiograph (C) after completing treatment. Case 2. STIR MRI (D) demonstrating signal suggestive of ligamentous injury. Initial radiograph (E) demonstrating widening of C1–2 posteriorly (arrow). Initial CT (F) demonstrating right posterior arch fracture (arrow). Four-month imaging (G–I) after completion of treatment. Case 3. Initial radiograph (J) demonstrating kyphosis and mild anterolisthesis of C1 on C2. CT (K) demonstrating bilateral pars interarticularis fracture. Two-month radiograph (L) after completing treatment.