Pediatric Spinal Cord Contusion: A Case Report Highlighting Clinical Symptoms and Management Strategies in a 2-Year-Old Patient

Dewa Gede Chriswidarma, Anak Agung Ngurah Agung Harawikrama Adityawarma, Christopher Lauren, Agung Bagus Sista Satyarsa, I Putu Pramana Suarjaya, Tjokorda Gde Bagus Mahadewa

Abstract


Spinal cord injuries (SCI) can be resulted in permanent disability, often caused by high-intensity incidents such as car accidents, falls, and violent crimes. Although relatively rare in children, they can have profound effects. This case report was aimed to elucidate the clinical symptoms of Th1-Th3 spinal contusion in a 2-year-old patient. A 2-year-old boy presented to a private peripheral hospital with complaints of back pain following a traffic accident. The examination revealed complete motor weakness (0/5) in both lower extremities, with preserved sacral sparing. Thoracolumbar MRI demonstrated spinal cord contusion and edema at the level of Th1-Th3. Based on history, physical examination, and supporting tests, the patient was diagnosed with SCI ASIA Impairment Scale B and upper thoracic spinal cord contusion, leading to the decision to perform laminectomy at the Th2-Th3 level. This case underscores the importance of recognizing initial symptoms in spinal cord injury cases and being vigilant for red flags in spinal trauma cases. Prompt initial trauma treatment, such as patient immobilization, is crucial. In this instance, laminectomy decompression was undertaken to address the contusion. A high level of vigilance was required as neurological symptoms could evolve or be initially obscured. Spinal cord injuries often manifest within days of an accident, although they can remain undetected for extended periods. Cord contusions may present with neurological symptoms, necessitating prompt diagnosis via spinal magnetic resonance imaging (MRI) and potential emergency surgical intervention, such as laminectomy.


Keywords


Cord contusion; Neurosurgical procedures; Paraplegia; Spinal cord injury

Full Text:

PDF

References


Cunha NSC, Malvea A, Sadat S, Ibrahim GM, Fehlings MG. Pediatric spinal cord injury: a review. Children. 2023;10(9):1–30. Doi: 10.3390/children10091456

Benmelouka A, Shamseldin LS, Nourelden AZ, Negida A. A review on the etiology and management of pediatric traumatic spinal cord injuries. Adv J Emerg Med. 2019;4(2):e28. Doi: 0.22114/ajem.v0i0.256

Mallory A, Stammen J, Zhu M. Cervical and thoracic spine injury in pediatric motor vehicle crash passengers. Traffic Inj Prev. 2019;20(1):84–92. Doi: 10.1080/15389588.2018.1529412

Coulthard MG, Varghese V, Harvey LP, Gillen TC, Kimble RM, Ware RS. A review of children with severe trauma admitted to pediatric intensive care in Queensland, Australia. PLoS One. 2019;14(2):1–9. Doi: https://doi.org/10.1371/journal. pone.0211530

Mahr D, Freigang V, Bhayana H, Kerschbaum M, Frankewycz B, Loibl M, et al. Comprehensive treatment algorithm for atlanto-axial rotatory fixation (AARF) in children. Eur J Trauma Emerg Surg. 2021;47(3):713–8. Doi: https://doi.org/10.1007/s00068-019-01096-3

Ward CE, Badolato GM, Breslin K, Brown K, Simpson JN. Evaluation of a selective prehospital pediatric spinal protection protocol. Prehospital Emerg care. 2019;23(6):862–69. Doi: 10.1080/10903127.2019.1585502

Poorman GW, Segreto FA, Beaubrun BM, Jalai CM, Horn SR, Bortz CA, et al. Traumatic fracture of the pediatric cervical spine: Etiology, epidemiology, concurrent injuries, and an analysis of perioperative outcomes using the kids’ inpatient database. Int J Spine Surg. 2019;13(1):68–78. Doi: 10.14444/6009

Mandadi A, Koutsogiannis P, Das J. Pediatric spine trauma. [Internet]. StatPearls Publishing. 2025. Available from: https://www.ncbi.nlm.nih.gov/books/NBK442027/%0A

Parent S, Mac-Thiong JM, Roy-Beaudry M, Sosa JF, Labelle H. Spinal cord injury in the pediatric population: A systematic review of the literature. J Neurotrauma. 2011;28(8):1515–24. Doi: 10.1089/neu.2009.1153

Ziu E, Weisbrod LJ, Mesfin FB. Spinal Shock. In Treasure Island (FL); 2025. Available from: https://europepmc.org/article/NBK/nbk448163

Brigham E, Brady J, Olympia RP. School Nurses on the Front Lines of Medicine: Emergencies Associated With Sport and Physical Activities: Part 1. NASN Sch Nurse. 2019;34(3):155–61. Doi: 10.1177/1942602X18819223

Phuntsok R, Ellis BJ, Herron MR, Provost CW, Dailey AT, Brockmeyer DL. The occipitoatlantal capsular ligaments are the primary stabilizers of the occipitoatlantal joint in the craniocervical junction: a finite element analysis. J Neurosurg Spine. 2019;30(5):593–601. Doi: 10.3171/2018.10.SPINE181102

Boese CK, Müller D, Bröer R, Eysel P, Krischek B, Lehmann HC, et al. Spinal cord injury without radiographic abnormality (SCIWORA) in adults: MRI type predicts early neurologic outcome. Spinal Cord. 2016;54(10):878–83. Doi: 10.1038/sc.2016.13

Franklin DB 3rd, Hardaway AT, Sheffer BW, Spence DD, Kelly DM, Muhlbauer MS, et al. The role of computed tomography and magnetic resonance imaging in the diagnosis of pediatric thoracolumbar compression fractures. J Pediatr Orthop. 2019;39(7):e520–3. Doi: 10.1097/BPO.0000000000001316

Vizoso FJ, Eiro N, Cid S, Schneider J, Perez-Fernandez R. Mesenchymal stem cell secretome: toward cell-free therapeutic strategies in regenerative medicine. Int J Mol Sci. 2017;18(9): 1-24. Doi: 10.3390/ijms18091852

Jin MC, Medress ZA, Azad TD, Doulames VM, Veeravagu A. Stem cell therapies for acute spinal cord injury in humans: a review. Neurosurg Focus. 2019;46(3):E10. Doi: 10.3171/2018.12.FOCUS18602

Badhiwala JH, Wilson JR, Witiw CD, Harrop JS, Vaccaro AR, Aarabi B, et al. The influence of timing of surgical decompression for acute spinal cord injury: a pooled analysis of individual patient data. Lancet Neurol. 2021;20(2):117–26. Doi: 10.1016/S1474-4422(20)30406-3

Eleraky MA, Theodore N, Adams M, Rekate HL, Sonntag VK. Pediatric cervical spine injuries: report of 102 cases and review of the literature. J Neurosurg. 2000;92(1 Suppl):12–7. Doi: 10.3171/spi.2000.92.1.0012

Suskauer SJ, Yeates KO, Sarmiento K, Benzel EC, Breiding MJ, Broomand C, et al. Strengthening the evidence base: recommendations for future research identified through the development of CDC’s pediatric mild TBI guideline. J Head Trauma Rehabil. 2019;34(4):215–23. Doi: 10.1097/HTR.0000000000000455

Kommaraju K, Haynes JH, Ritter AM. Evaluating the role of a neurosurgery consultation in management of pediatric isolated linear skull fractures. Pediatr Neurosurg. 2019;54(1):21–7. Doi: 10.1159/000495792




DOI: https://doi.org/10.24244/jni.v14i3.692

Refbacks

  • There are currently no refbacks.


 

JNIis licensed under a Creative Commons Attribution-NonCommercial-ShareAlike 4.0 International License