Spinal cord birth injury is rare, and orthopaedic surgeons infrequently encounter it. The injury is associated with hyperextension of the fetal head in utero and during delivery and with forceps-assisted breech vaginal deliveries. These cervical spinal cord injures may be complete or partial. They most commonly occur in the absence of bony injury, which can lead to diagnostic difficulties. Ultrasound and MRI studies are valuable diagnostic tools for identifying spinal cord injury in cases of hypotonic newborns with difficult deliveries. The authors report an unusual case of spinal cord birth injury with frank cervical fracture-dislocation following a difficult footling breech vaginal delivery. Early recognition of hyperextension of the fetal head in utero and planned cesarean section are important prevention methods. While this type of injury is rare, the pediatric orthopedic surgeon must understand its nature and severity to facilitate timely treatment.
From the *Department of Orthopaedic Surgery, University of Michigan, Ann Arbor, Michigan; and the †Division of Orthopaedic Surgery, University of Pennsylvania, Philadelphia, Pennsylvania.
Study conducted at the Children's Hospital of Philadelphia, Philadelphia, Pennsylvania.
None of the authors received financial support for this study.
Reprints: Denis S. Drummond, MD, Division of Orthopaedics, 2nd Floor, Wood Bldg., Children's Hospital of Philadelphia, 34th Street and Civic Center Blvd., Philadelphia, PA 19104 (e-mail: Drummond@email.chop.edu).