One page summary: Spinal cord injury at birth

In two sentences

A spinal cord injury at birth means the bundle of nerves running down the spine was damaged during delivery. It affects movement and feeling below the level of the injury, and it can affect breathing if the injury is high in the neck. ¹

It is rare. It is also easy to miss at first, because a floppy, weak newborn looks like a baby with a brain problem or a muscle condition, and the spine is not always the first thing considered. The distinguishing feature is weakness with a level: normal function above a point and absent function below it. ¹

The numbers, with their sources

• How rare. Spinal cord injury at birth is uncommon compared with the other birth injuries on this site, and no current national surveillance figure is published for it ²
• The usual mechanism. Stretching or twisting of the neck during delivery, particularly where the head and body are pulled in different directions ¹
• The main associations. Breech delivery with a difficult head delivery, and difficult instrument-assisted births ³
• The right test. MRI of the spine. X-ray is frequently normal, because a newborn spine can stretch and injure the cord without the bones showing damage ¹
• The clinical clue. A level. Function is preserved above a point on the body and absent below it, which does not fit a brain or muscle cause ¹
• Breathing risk. An injury high in the neck can affect the nerves that drive the diaphragm, so breathing must be assessed ⁴

What to do this week

1. Ask whether an MRI of the spine has been done. A normal X-ray does not rule this out.
2. Ask what level the injury is at, and whether it is complete or incomplete.
3. Ask whether the diaphragm is working.
4. Ask whether the bladder is emptying, and what the plan is.
5. Ask for referral to a center that manages spinal cord injury.
6. Request the complete delivery records, including the mode of delivery and any breech or shoulder dystocia notes.
7. Refer to early intervention.

Questions to take with you

Take these with you. Write the answers down in the moment, because you will not remember them later.

For the neonatologist or neurologist

• Has an MRI of the spine been done, and what did it show?
• What level is the injury, and is it complete or incomplete?
• Is the diaphragm working on both sides?
• Is the bladder emptying, and how are we managing that?
• What recovery, if any, would you expect over the first months?

For the rehabilitation team

• What equipment will we need in the first year?
• When can we start powered mobility?
• How do we do the bladder and bowel program?
• What skin checks should we do, and how often?
• When does scoliosis monitoring start?

For the obstetric team

• What was the mode of delivery, and was it breech?
• Was the head hyperextended before delivery?
• Were instruments used, and was there rotation?
• Is all of this in the delivery note?

You can also build a printable list with the question generator.

Where to read more

The full page on this condition covers how it happens, causes split into what happens even with perfect care and what is associated with gaps in care, signs by age, diagnosis, treatment, outlook, daily life and lifetime cost.

Read the full page on Spinal cord injury at birth

Related pages are listed at the bottom of it, including the events that can lead to this condition and the guides that cover therapy, school and money.