Trauma usually occurs in breech deliveries after excess longitudinal traction to the spine. When the injury is higher, the lesions are generally fatal because respiration is compromised. Sometimes a click or snap is heard at delivery. Usually, there is patchy retention of sensation or movement below the lesion. Spinal shock with flaccidity below the level of injury occurs initially.
Spasticity develops within days or weeks.
When the spinal cord lesion is complete, the intercostal and abdominal muscles become paralyzed, and rectal and bladder sphincters cannot develop voluntary control. Sensation and sweating are lost below the involved level and can result in fluctuations of body temperature with environmental changes. An MRI of the cervical cord may demonstrate the lesion and excludes surgically treatable lesions, such as congenital tumors or hematomas pressing on the cord. The CSF usually is bloody. Prognosis and Treatment With appropriate care, most infants survive for many years.