{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,2,6]],"date-time":"2026-02-06T04:47:59Z","timestamp":1770353279878,"version":"3.49.0"},"reference-count":38,"publisher":"Journal of Neurosurgery Publishing Group (JNSPG)","issue":"10","license":[{"start":{"date-parts":[[2023,3,6]],"date-time":"2023-03-06T00:00:00Z","timestamp":1678060800000},"content-version":"unspecified","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":[],"published-print":{"date-parts":[[2023,3,6]]},"abstract":"<jats:sec>\n                    <jats:title>BACKGROUND<\/jats:title>\n                    <jats:p>Cervical spine injuries in neonates are rare and no guidelines are available to inform management. The most common etiology of neonatal cervical injury is birth-related trauma. Management strategies that are routine in older children and adults are not feasible due to the unique anatomy of neonates.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>OBSERVATIONS<\/jats:title>\n                    <jats:p>Here, the authors present 3 cases of neonatal cervical spinal injury due to confirmed or suspected birth trauma, 2 of whom presented immediately after birth, while the other was diagnosed at 7 weeks of age. One child presented with neurological deficits due to spinal cord injury, while another had an underlying predisposition to bony injury, infantile malignant osteopetrosis. The children were treated with a custom-designed and manufactured full-body external orthoses with good clinical and radiographic outcomes. A narrative literature review further supplements this case series and highlights risk factors and the spectrum of birth-related spinal injuries reported to date.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>LESSONS<\/jats:title>\n                    <jats:p>The current report highlights the importance of recognizing the rare occurrence of cervical spinal injury in newborns and provides pragmatic recommendations for management of these injuries. Custom orthoses provide an alternate option for neonates who cannot be fitted in halo vests and who would outgrow traditional casts.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.3171\/case22455","type":"journal-article","created":{"date-parts":[[2023,3,6]],"date-time":"2023-03-06T08:10:45Z","timestamp":1678090245000},"source":"Crossref","is-referenced-by-count":1,"title":["Management of perinatal cervical spine injury using custom-fabricated external orthoses: design considerations, narrative literature review, and experience from the Hospital for Sick Children. Illustrative cases"],"prefix":"10.3171","volume":"5","author":[{"given":"Vishwathsen","family":"Karthikeyan","sequence":"first","affiliation":[{"name":"Division of Neurosurgery, University of Toronto, Toronto, Ontario, Canada"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Sara C.","family":"Breitbart","sequence":"additional","affiliation":[{"name":"Hospital for Sick Children, University of Toronto, Toronto, Ontario, Canada; and"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Armaan K.","family":"Malhotra","sequence":"additional","affiliation":[{"name":"Division of Neurosurgery, University of Toronto, Toronto, Ontario, Canada"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Andrea","family":"Fung","sequence":"additional","affiliation":[{"name":"Hospital for Sick Children, University of Toronto, Toronto, Ontario, Canada; and"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Erin","family":"Short","sequence":"additional","affiliation":[{"name":"Hospital for Sick Children, University of Toronto, Toronto, Ontario, Canada; and"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Ann","family":"Schmitz","sequence":"additional","affiliation":[{"name":"Division of Neurosurgery, University of Toronto, Toronto, Ontario, Canada"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"David E.","family":"Lebel","sequence":"additional","affiliation":[{"name":"Hospital for Sick Children, University of Toronto, Toronto, Ontario, Canada; and"},{"name":"Division of Orthopedics, University of Toronto, Toronto, Ontario, Canada"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"George M.","family":"Ibrahim","sequence":"additional","affiliation":[{"name":"Division of Neurosurgery, University of Toronto, Toronto, Ontario, Canada"},{"name":"Hospital for Sick Children, University of Toronto, Toronto, Ontario, Canada; and"}],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"1754","reference":[{"key":"b1","series-title":"Front Pediatr","first-page":"514","article-title":"Unusual presentations of birth related cervical spinal cord injury","volume":"8","author":"Lee CC","year":"2020","unstructured":"Lee CC, Chou IJ, Chang YJ, Chiang MC. Unusual presentations of birth related cervical spinal cord injury. Front Pediatr. 2020;8:514.33117760"},{"issue":"4","key":"b2","series-title":"J Pediatr Orthop","first-page":"484","article-title":"Cervical spine fracture-dislocation birth injury: prevention, recognition, and implications for the orthopaedic surgeon","volume":"25","author":"Caird MS","year":"2005","unstructured":"Caird MS, Reddy S, Ganley TJ, Drummond DS. Cervical spine fracture-dislocation birth injury: prevention, recognition, and implications for the orthopaedic surgeon. J Pediatr Orthop. 2005;25(4):484\u2013486.15958900"},{"issue":"1","key":"b3","series-title":"Neurosurgery","first-page":"E1","article-title":"Pediatric spine trauma: a brief review","volume":"87","author":"Alexiades NG","year":"2020","unstructured":"Alexiades NG, Parisi F, Anderson RCE. Pediatric spine trauma: a brief review. Neurosurgery. 2020;87(1):E1\u2013E9.32374883"},{"issue":"6","key":"b4","series-title":"J Matern Fetal Neonatal Med","first-page":"435","article-title":"Spinal cord injuries at birth: a multicenter review of nine cases","volume":"20","author":"Vialle R","year":"2007","unstructured":"Vialle R, Pi\u00e9tin-Vialle C, Ilharreborde B, Dauger S, Vinchon M, Glorion C. Spinal cord injuries at birth: a multicenter review of nine cases. J Matern Fetal Neonatal Med. 2007;20(6):435\u2013440.17674252"},{"issue":"1","key":"b5","series-title":"J Neurosurg Pediatr","first-page":"16","article-title":"Successful surgical repair and recovery in a 2-week-old infant after birth-related cervical fracture dislocation","volume":"21","author":"Saleh S","year":"2018","unstructured":"Saleh S, Swanson KI, Bragg T. Successful surgical repair and recovery in a 2-week-old infant after birth-related cervical fracture dislocation. J Neurosurg Pediatr. 2018;21(1):16\u201320."},{"key":"b6","series-title":"Crit Care Med","first-page":"S489","article-title":"Spinal cord injury","volume":"30","author":"Proctor MR","year":"2002","unstructured":"Proctor MR. Spinal cord injury. Crit Care Med. 2002;30(11 Suppl):S489\u2013S499.12528791"},{"issue":"10","key":"b7","series-title":"J Pediatr Surg","first-page":"1774","article-title":"Fracture of the occipital condyle caused by minor trauma in child","volume":"41","author":"Kapapa T","year":"2006","unstructured":"Kapapa T, Tschan CA, K\u00f6nig K,  Fracture of the occipital condyle caused by minor trauma in child. J Pediatr Surg. 2006;41(10):1774\u20131776.17011288"},{"issue":"5","key":"b8","series-title":"Spine J","first-page":"584","article-title":"Spinal injury considerations in the competitive diver: a case report and review of the literature","volume":"4","author":"Badman BL","year":"2004","unstructured":"Badman BL, Rechtine GR. Spinal injury considerations in the competitive diver: a case report and review of the literature. Spine J. 2004;4(5):584\u2013590."},{"issue":"3","key":"b9","series-title":"Childs Nerv Syst","first-page":"343","article-title":"Unstable upper pediatric cervical spine injuries: report of 28 cases and review of the literature","volume":"24","author":"Duhem R","year":"2008","unstructured":"Duhem R, Tonnelle V, Vinchon M, Assaker R, Dhellemmes P. Unstable upper pediatric cervical spine injuries: report of 28 cases and review of the literature. Childs Nerv Syst. 2008;24(3):343\u2013348.17912535"},{"issue":"1","key":"b10","series-title":"J Bone Joint Surg Am","first-page":"71","article-title":"Incidence of and risk factors for complications associated with halo-vest immobilization: a prospective, descriptive cohort study of 239 patients","volume":"91","author":"van Middendorp JJ","year":"2009","unstructured":"van Middendorp JJ, Slooff WB, Nellestein WR, Oner FC. Incidence of and risk factors for complications associated with halo-vest immobilization: a prospective, descriptive cohort study of 239 patients. J Bone Joint Surg Am. 2009;91(1):71\u201379.19122081"},{"issue":"4","key":"b11","series-title":"Spine (Phila Pa 1976)","first-page":"283","article-title":"Pediatric cervical spine and spinal cord injury: a national database study","volume":"41","author":"Shin JI","year":"2016","unstructured":"Shin JI, Lee NJ, Cho SK. Pediatric cervical spine and spinal cord injury: a national database study. Spine (Phila Pa 1976). 2016;41(4):283\u2013292.26555836"},{"issue":"1","key":"b12","series-title":"Childs Nerv Syst","first-page":"5","article-title":"Fatal neonatal spinal cord injury during shoulder dystocia","volume":"38","author":"Habek D","year":"2022","unstructured":"Habek D. Fatal neonatal spinal cord injury during shoulder dystocia. Childs Nerv Syst. 2022;38(1):5\u20136.34632526"},{"issue":"1","key":"b13","series-title":"J Pediatr","first-page":"105","article-title":"Upper cervical spinal cord injury in neonates: the use of magnetic resonance imaging","volume":"138","author":"Mills JF","year":"2001","unstructured":"Mills JF, Dargaville PA, Coleman LT, Rosenfeld JV, Ekert PG. Upper cervical spinal cord injury in neonates: the use of magnetic resonance imaging. J Pediatr. 2001;138(1):105\u2013108.11148521"},{"issue":"4","key":"b14","series-title":"Dev Med Child Neurol","first-page":"274","article-title":"Cervical spinal cord injury following cephalic presentation and delivery by Caesarean section","volume":"43","author":"Morgan C","year":"2001","unstructured":"Morgan C, Newell SJ. Cervical spinal cord injury following cephalic presentation and delivery by Caesarean section. Dev Med Child Neurol. 2001;43(4):274\u2013276.11305406"},{"issue":"1","key":"b15","series-title":"Pediatr Neurol","first-page":"69","article-title":"Neonatal spinal cord injury after an uncomplicated vaginal delivery","volume":"42","author":"Goetz E","year":"2010","unstructured":"Goetz E. Neonatal spinal cord injury after an uncomplicated vaginal delivery. Pediatr Neurol. 2010;42(1):69\u201371.20004868"},{"key":"b16","series-title":"BMJ Case Rep","first-page":"bcr2012007533","article-title":"Remarkable recovery in an infant presenting with extensive perinatal cervical cord injury","volume":"2012","author":"Ul Haq I","year":"2012","unstructured":"Ul Haq I, Gururaj AK. Remarkable recovery in an infant presenting with extensive perinatal cervical cord injury. BMJ Case Rep. 2012;2012:bcr2012007533."},{"issue":"1","key":"b17","series-title":"Case Rep Perinat Med","first-page":"73","article-title":"Neonatal spinal cord injury after an uncomplicated caesarean section","volume":"5","author":"Fazzi A","year":"2016","unstructured":"Fazzi A, Messner H, Stuefer J, Staffler A. Neonatal spinal cord injury after an uncomplicated caesarean section. Case Rep Perinat Med. 2016;5(1):73\u201375."},{"issue":"6","key":"b18","series-title":"Acta Paediatr","first-page":"824","article-title":"Spinal cord injury at birth: a hidden causative factor","volume":"97","author":"Fenger-Gron J","year":"2008","unstructured":"Fenger-Gron J, Kock K, Nielsen RG, Leth PM, Illum N. Spinal cord injury at birth: a hidden causative factor. Acta Paediatr. 2008;97(6):824\u2013826.18397356"},{"issue":"13","key":"b19","series-title":"Medicine (Baltimore)","first-page":"e25334","article-title":"Conservative treatment and outcome of upper cervical spine fractures in young children: a STROBE-compliant case series","volume":"100","author":"Tomaszewski R","year":"2021","unstructured":"Tomaszewski R, Sesia SB, Studer D, Rutz E, Mayr JM. Conservative treatment and outcome of upper cervical spine fractures in young children: a STROBE-compliant case series. Medicine (Baltimore). 2021;100(13):e25334.33787631"},{"key":"b1","series-title":"Front Pediatr","first-page":"514","article-title":"Unusual presentations of birth related cervical spinal cord injury","volume":"8","author":"Lee CC","year":"2020","unstructured":"Lee CC, Chou IJ, Chang YJ, Chiang MC. Unusual presentations of birth related cervical spinal cord injury. Front Pediatr. 2020;8:514.33117760"},{"issue":"4","key":"b2","series-title":"J Pediatr Orthop","first-page":"484","article-title":"Cervical spine fracture-dislocation birth injury: prevention, recognition, and implications for the orthopaedic surgeon","volume":"25","author":"Caird MS","year":"2005","unstructured":"Caird MS, Reddy S, Ganley TJ, Drummond DS. Cervical spine fracture-dislocation birth injury: prevention, recognition, and implications for the orthopaedic surgeon. J Pediatr Orthop. 2005;25(4):484\u2013486.15958900"},{"issue":"1","key":"b3","series-title":"Neurosurgery","first-page":"E1","article-title":"Pediatric spine trauma: a brief review","volume":"87","author":"Alexiades NG","year":"2020","unstructured":"Alexiades NG, Parisi F, Anderson RCE. Pediatric spine trauma: a brief review. Neurosurgery. 2020;87(1):E1\u2013E9.32374883"},{"issue":"6","key":"b4","series-title":"J Matern Fetal Neonatal Med","first-page":"435","article-title":"Spinal cord injuries at birth: a multicenter review of nine cases","volume":"20","author":"Vialle R","year":"2007","unstructured":"Vialle R, Pi\u00e9tin-Vialle C, Ilharreborde B, Dauger S, Vinchon M, Glorion C. Spinal cord injuries at birth: a multicenter review of nine cases. J Matern Fetal Neonatal Med. 2007;20(6):435\u2013440.17674252"},{"issue":"1","key":"b5","series-title":"J Neurosurg Pediatr","first-page":"16","article-title":"Successful surgical repair and recovery in a 2-week-old infant after birth-related cervical fracture dislocation","volume":"21","author":"Saleh S","year":"2018","unstructured":"Saleh S, Swanson KI, Bragg T. Successful surgical repair and recovery in a 2-week-old infant after birth-related cervical fracture dislocation. J Neurosurg Pediatr. 2018;21(1):16\u201320."},{"key":"b6","series-title":"Crit Care Med","first-page":"S489","article-title":"Spinal cord injury","volume":"30","author":"Proctor MR","year":"2002","unstructured":"Proctor MR. Spinal cord injury. Crit Care Med. 2002;30(11 Suppl):S489\u2013S499.12528791"},{"issue":"10","key":"b7","series-title":"J Pediatr Surg","first-page":"1774","article-title":"Fracture of the occipital condyle caused by minor trauma in child","volume":"41","author":"Kapapa T","year":"2006","unstructured":"Kapapa T, Tschan CA, K\u00f6nig K,  Fracture of the occipital condyle caused by minor trauma in child. J Pediatr Surg. 2006;41(10):1774\u20131776.17011288"},{"issue":"5","key":"b8","series-title":"Spine J","first-page":"584","article-title":"Spinal injury considerations in the competitive diver: a case report and review of the literature","volume":"4","author":"Badman BL","year":"2004","unstructured":"Badman BL, Rechtine GR. Spinal injury considerations in the competitive diver: a case report and review of the literature. Spine J. 2004;4(5):584\u2013590."},{"issue":"3","key":"b9","series-title":"Childs Nerv Syst","first-page":"343","article-title":"Unstable upper pediatric cervical spine injuries: report of 28 cases and review of the literature","volume":"24","author":"Duhem R","year":"2008","unstructured":"Duhem R, Tonnelle V, Vinchon M, Assaker R, Dhellemmes P. Unstable upper pediatric cervical spine injuries: report of 28 cases and review of the literature. Childs Nerv Syst. 2008;24(3):343\u2013348.17912535"},{"issue":"1","key":"b10","series-title":"J Bone Joint Surg Am","first-page":"71","article-title":"Incidence of and risk factors for complications associated with halo-vest immobilization: a prospective, descriptive cohort study of 239 patients","volume":"91","author":"van Middendorp JJ","year":"2009","unstructured":"van Middendorp JJ, Slooff WB, Nellestein WR, Oner FC. Incidence of and risk factors for complications associated with halo-vest immobilization: a prospective, descriptive cohort study of 239 patients. J Bone Joint Surg Am. 2009;91(1):71\u201379.19122081"},{"issue":"4","key":"b11","series-title":"Spine (Phila Pa 1976)","first-page":"283","article-title":"Pediatric cervical spine and spinal cord injury: a national database study","volume":"41","author":"Shin JI","year":"2016","unstructured":"Shin JI, Lee NJ, Cho SK. Pediatric cervical spine and spinal cord injury: a national database study. Spine (Phila Pa 1976). 2016;41(4):283\u2013292.26555836"},{"issue":"1","key":"b12","series-title":"Childs Nerv Syst","first-page":"5","article-title":"Fatal neonatal spinal cord injury during shoulder dystocia","volume":"38","author":"Habek D","year":"2022","unstructured":"Habek D. Fatal neonatal spinal cord injury during shoulder dystocia. Childs Nerv Syst. 2022;38(1):5\u20136.34632526"},{"issue":"1","key":"b13","series-title":"J Pediatr","first-page":"105","article-title":"Upper cervical spinal cord injury in neonates: the use of magnetic resonance imaging","volume":"138","author":"Mills JF","year":"2001","unstructured":"Mills JF, Dargaville PA, Coleman LT, Rosenfeld JV, Ekert PG. Upper cervical spinal cord injury in neonates: the use of magnetic resonance imaging. J Pediatr. 2001;138(1):105\u2013108.11148521"},{"issue":"4","key":"b14","series-title":"Dev Med Child Neurol","first-page":"274","article-title":"Cervical spinal cord injury following cephalic presentation and delivery by Caesarean section","volume":"43","author":"Morgan C","year":"2001","unstructured":"Morgan C, Newell SJ. Cervical spinal cord injury following cephalic presentation and delivery by Caesarean section. Dev Med Child Neurol. 2001;43(4):274\u2013276.11305406"},{"issue":"1","key":"b15","series-title":"Pediatr Neurol","first-page":"69","article-title":"Neonatal spinal cord injury after an uncomplicated vaginal delivery","volume":"42","author":"Goetz E","year":"2010","unstructured":"Goetz E. Neonatal spinal cord injury after an uncomplicated vaginal delivery. Pediatr Neurol. 2010;42(1):69\u201371.20004868"},{"key":"b16","series-title":"BMJ Case Rep","first-page":"bcr2012007533","article-title":"Remarkable recovery in an infant presenting with extensive perinatal cervical cord injury","volume":"2012","author":"Ul Haq I","year":"2012","unstructured":"Ul Haq I, Gururaj AK. Remarkable recovery in an infant presenting with extensive perinatal cervical cord injury. BMJ Case Rep. 2012;2012:bcr2012007533."},{"issue":"1","key":"b17","series-title":"Case Rep Perinat Med","first-page":"73","article-title":"Neonatal spinal cord injury after an uncomplicated caesarean section","volume":"5","author":"Fazzi A","year":"2016","unstructured":"Fazzi A, Messner H, Stuefer J, Staffler A. Neonatal spinal cord injury after an uncomplicated caesarean section. Case Rep Perinat Med. 2016;5(1):73\u201375."},{"issue":"6","key":"b18","series-title":"Acta Paediatr","first-page":"824","article-title":"Spinal cord injury at birth: a hidden causative factor","volume":"97","author":"Fenger-Gron J","year":"2008","unstructured":"Fenger-Gron J, Kock K, Nielsen RG, Leth PM, Illum N. Spinal cord injury at birth: a hidden causative factor. Acta Paediatr. 2008;97(6):824\u2013826.18397356"},{"issue":"13","key":"b19","series-title":"Medicine (Baltimore)","first-page":"e25334","article-title":"Conservative treatment and outcome of upper cervical spine fractures in young children: a STROBE-compliant case series","volume":"100","author":"Tomaszewski R","year":"2021","unstructured":"Tomaszewski R, Sesia SB, Studer D, Rutz E, Mayr JM. Conservative treatment and outcome of upper cervical spine fractures in young children: a STROBE-compliant case series. Medicine (Baltimore). 2021;100(13):e25334.33787631"}],"container-title":["Journal of Neurosurgery: Case Lessons"],"original-title":[],"link":[{"URL":"https:\/\/thejns.org\/view\/journals\/j-neurosurg-case-lessons\/5\/10\/article-CASE22455.xml","content-type":"text\/html","content-version":"vor","intended-application":"text-mining"},{"URL":"https:\/\/thejns.org\/downloadpdf\/journals\/j-neurosurg-case-lessons\/5\/10\/article-CASE22455.xml","content-type":"text\/html","content-version":"vor","intended-application":"syndication"},{"URL":"https:\/\/thejns.org\/downloadpdf\/journals\/j-neurosurg-case-lessons\/5\/10\/article-CASE22455.xml","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2026,2,5]],"date-time":"2026-02-05T14:30:16Z","timestamp":1770301816000},"score":1,"resource":{"primary":{"URL":"https:\/\/thejns.org\/view\/journals\/j-neurosurg-case-lessons\/5\/10\/article-CASE22455.xml"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2023,3,6]]},"references-count":38,"journal-issue":{"issue":"10"},"URL":"https:\/\/doi.org\/10.3171\/case22455","relation":{},"ISSN":["2694-1902"],"issn-type":[{"value":"2694-1902","type":"electronic"}],"subject":[],"published":{"date-parts":[[2023,3,6]]}}}