Non-Contiguous Cervical and Thoracic Spinal Cord Injuries After Severe Polytrauma: A Case Report

Background and Clinical Significance: Non-contiguous traumatic spinal cord injury (SCI) can be difficult to recognise and classify in severe polytrauma, especially when traumatic brain injury (TBI) and limb injuries limit neurological examination. Case Presentation: A 17-year-old male was involved in a motorcycle accident resulting in severe polytrauma with TBI. Brain magnetic resonance imaging (MRI) showed a grade III diffuse axonal injury. Trauma computed tomography (CT) identified C2 and T3–T5 vertebral fractures. Spinal MRI revealed a non-haemorrhagic C3–C6 contusive myelopathy, a T4 spinal cord contusion, and a thoracic posterior epidural haematoma. He underwent posterior T2–T7 fixation. Acute neurological examination was limited by impaired consciousness and associated injuries. At four months, the International Standards for Neurological Classification of Spinal Cord Injury (ISNCSCI) assessment showed a neurological level of C2, and a total motor score of 55. Electrodiagnostic testing showed active bilateral C5–T1 denervation. At seven months and one year, the total motor score increased to 63 and 82, respectively, accompanied by substantial functional improvement. Conclusions: In severe polytrauma with TBI, non-contiguous SCI should be considered when neurological examination is unreliable. In non-contiguous SCI, clinical assessment should integrate neurological examination, including quantitative motor and sensory scores, with imaging and neurophysiological studies, cognitive status, associated injuries, and functional outcomes.