BIRTH TRAUMA SPINAL CORD INJURY

birth trauma spinal cord injury incurred during delivery results from excessive traction or rotation. Traction is more important in breech deliveries (minority of cases), and torsion is more significant in vertex deliveries. True incidence is difficult to determine. The lower cervical and upper thoracic region for breech delivery and the upper and midcervical region for vertex delivery are the major sites of injury. Major neuropathologic changes consist of acute lesions, which are hemorrhages, especially epidural, intraspinal, and edema. Hemorrhagic lesions are associated with varying degrees of stretching, laceration, and disruption or total transaction.

Occasionally, the dura may be torn, and rarely, the vertebral fractures or dislocations may be observed. The clinical presentation is stillbirth or rapid neonatal death with failure to establish adequate respiratory function, especially in cases involving the upper cervical cord or lower brain stem. Severe respiratory failure may be obscured by mechanical ventilation and may cause ethical issues later. The infant may survive with weakness and hypotonia, and the true etiology may not be recognized.

A neuromuscular disorder or transient hypoxic ischemic encephalopathy may be considered. Most infants later develop spasticity that may be mistaken for cerebral palsy. Prevention is the most important aspect of medical care. Obstetric management of breech deliveries, instrumental deliveries, and pharmacologic augmentation of labor must be appropriate. Occasionally, injury may be sustained in utero.

The diagnosis is made by MRI or CT myelography. Little evidence indicates that laminectomy or decompression has anything to offer. A potential role for methylprednisolone exists. Supportive therapy is important.