Infant Spinal Cord Injuries

What is an infant spinal cord injury?

An infant spinal cord injury is damage to the spinal cord sustained during birth, most often when the baby’s neck is subjected to excessive stretching, twisting, or bending as the head and body are delivered. It is rare, but it is among the most serious birth injuries, because the spinal cord carries every signal between the brain and the body below the neck. A newborn’s spine is highly elastic while the cord inside it is not, so the vertebrae can stretch far enough to injure the cord even without an obvious fracture, an injury pattern known in the literature as SCIWORA (spinal cord injury without radiographic abnormality).

The upper cervical (neck) region is the most commonly injured, because it bears the forces of delivering the head. The consequences depend on where along the cord the injury occurs and how complete it is.

Causes: traction, rotation, and breech

• Excessive longitudinal traction: pulling on the head or body stretches the neck; the classic mechanism, and the one shared with brachial plexus injury when force is misapplied.
• Rotational (torsional) force: twisting the head and neck during a difficult delivery, particularly with mid-forceps rotation.
• Hyperextension of the fetal neck: a “star-gazing” posture, especially in breech presentation, can overstretch the cord during delivery.
• Breech delivery: the head is delivered last, and traction on the trunk with an extended or hyperextended neck is a recognized risk.
• Instrumented delivery with excessive or misdirected force.

Levels of injury and what they affect

Injuries may be complete (no function below the level) or incomplete (some function preserved), an important distinction for prognosis.

Signs and symptoms

• Floppiness (hypotonia) and reduced or absent movement below the injury
• Weak or absent reflexes; a weak cry
• Breathing difficulty with high cervical injuries
• Absent response to stimulation below the level of injury
• Bladder distension or reduced bowel/bladder activity

Signs can be mistaken early on for other conditions such as hypoxic brain injury or a severe brachial plexus injury, which is why careful examination and imaging matter.

Diagnosis

MRI is the key test, because it can show cord injury even when X-rays are normal (the SCIWORA pattern). Examination maps the level and completeness of the injury. Because the early picture can overlap with hypoxic-ischemic encephalopathy and other conditions, a spinal cord injury is sometimes recognized only after other causes are considered, a delay that can matter.

Outcomes and prognosis

The picture is sobering but not uniform. High cervical complete injuries carry the gravest prognosis, sometimes affecting the ability to breathe independently and requiring lifelong ventilatory and total care. Lower and incomplete injuries have a wider range of outcomes, and some function can be preserved or recovered, particularly when the injury is incomplete. Rehabilitation (physical and occupational therapy, respiratory support, adaptive equipment, and specialized nursing) is lifelong for significant injuries. We will not pretend these injuries commonly resolve; many do not. What varies is the degree of function preserved and the intensity of care required.

Was it preventable?

Not every infant spinal cord injury is malpractice. A small number arise from unavoidable circumstances. But because these injuries are typically caused by mechanical force (excessive traction, twisting, or hyperextension of the neck), they raise pointed questions about how the delivery was conducted. The standard of care asks whether a breech or malpositioned delivery was managed to avoid neck hyperextension, whether rotational forceps were appropriate and correctly applied, whether excessive traction was used, and whether a cesarean should have been chosen. When avoidable force injured the cord, the injury may have been preventable.

Legal options for families

An infant spinal cord injury claim examines whether the delivery met the standard of care and whether a failure caused the injury. Given the mechanical mechanisms, these cases focus closely on the delivery records: the presentation, the maneuvers, the instruments, and the force described. The lifetime costs of a significant spinal cord injury are among the highest in all of birth-injury litigation, covering respiratory support, nursing, therapy, equipment, and home modification, the elements a life-care plan quantifies. Filing deadlines vary by state; see our statute of limitations guide.

Where your case is handled depends on where the birth occurred: Banville Law attorneys are licensed in New York and Washington, D.C.; The Weitz Firm attorneys are licensed in Pennsylvania and New Jersey; elsewhere, the alliance connects families with its vetted network of local birth injury attorneys.

Frequently asked questions

How does a baby get a spinal cord injury during birth?

Almost always through mechanical force on the neck (excessive traction, twisting or rotation, or hyperextension) as the head and body are delivered. Breech deliveries and rotational forceps carry particular risk because of the strain they can place on the neck.

Can an infant recover from a spinal cord injury?

It depends on the level and completeness. Incomplete injuries and lower-level injuries have a wider range of outcomes and some recovery is possible; high, complete cervical injuries carry the gravest prognosis and often require lifelong care. We give families the honest range rather than false reassurance.

What is SCIWORA?

Spinal cord injury without radiographic abnormality: cord damage that does not show on plain X-rays because a newborn’s elastic spine can stretch enough to injure the cord without fracturing bone. It is why MRI is essential for diagnosis.

Could my baby’s injury have been prevented with a C-section?

Sometimes. In certain high-risk situations (a breech baby with a hyperextended neck, for example) a cesarean can avoid the forces that injure the cord. Whether one was indicated in your case is exactly the kind of question a records review addresses.

Sources

This page is for general education and is not medical advice. Medical facts above are drawn from the cited primary sources; legal statements reflect the reviewing attorneys’ professional experience. Always consult your child’s physician about medical concerns.