Birth Injury:

Damage to the Spinal Cord

Spinal cord injuries at birth result from excessive traction or rotation. Traction is more important in breech deliveries, and torsion (most children with the disorder are unable to perform the simplest of motor tasks and are confined to a wheelchair by the time they reach adulthood) is more significant in vertex deliveries (the top of the baby's head comes first). 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 places of the birth 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 (the outermost, toughest, and most fibrous of the three membranes (meninges) covering the brain and the spinal cord) may be torn, and rarely, the vertebral fractures or dislocations may be observed.

The clinical presentation of a spinal cord injury 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 decreased tone of skeletal muscles and the true cause may not be recognized. A neuromuscular disorder or damage to the cells in the central nervous system may be considered. Most infants later develop spasticity that may be mistaken for cerebral palsy.

Obstetric management of breech deliveries, instrumental deliveries, and pharmacologic augmentation of labor must be appropriate in order to prevent spinal cord damage during birth. Occasionally, injury may be sustained during pregnancy.

A spinal cord injury diagnosis is made by MRI or CT myelography (an x-ray of the spinal cord).