SCI
Kevin Song, DO
Resident
NYU Langone
Bayside, New York, United States
Whitman Oehlermarx, DO
Resident
NYU Langone
New York, New York, United States
Renat Sukhov, MD
Attending
NYU
New York, New York, United States
Kevin Song, DO
NYU Langone
Bayside, New York, United States
A 9-year-old child with a history of traumatic T11 ASIA A spinal cord injury (SCI) sustained in a motor vehicle accident at age 3 has been followed in outpatient physiatry care. Management included spasticity treatment, neurogenic bowel and bladder guidance, and equipment support.
Initial spine MRI, at the time following the accident, revealed complete transection of the thoracic cord at T11–T12 with associated hemorrhage, contusion, and edema, along with extensive subarachnoid and epidural hemorrhages from T11 to L5. No surgical intervention was performed, and the patient’s neurological status remained unchanged until the onset of puberty, when spontaneous micturition and sensation during defecation were noted at routine follow-up.
Re-evaluation demonstrated improvement to T7 ASIA D. Repeat MRI, obtained 5 years post-injury, showed marked myelomalacia spanning 2.5 cm posterior to T11–T12 and minimal central canal dilation from T9 to T11.
Discussions: This case highlights an unusual neurological and functional recovery in a child with traumatic spinal cord injury. Despite a prolonged history of injury and initial MRI findings consistent with complete cord transection with presumed loss of long tracts, hemorrhage, and edema, the patient progressed unexpectedly from ASIA A to ASIA D. Such improvement cannot be explained by a single factor.
Pediatric patients demonstrate greater neuroplasticity, with the developing nervous system capable of reorganizing pathways and recruiting alternative circuits after injury. Additionally, what appears as a complete transection on MRI may not always represent true histological disruption, as preserved axons or partially spared white matter tracts can support recovery. Finally, early cord edema and hemorrhage may exaggerate the initial severity, with subsequent resolution restoring neural conduction.
Conclusions: This case illustrates the potential for substantial neurological improvement in a young patient initially classified as T11 ASIA A, who progressed to T7 ASIA D with long-term therapy.
