Successful management of severe pediatric cervical trauma emphasizing the role of surgical stabilization and intensive rehabilitation in achieving complete recovery: a case report

BACKGROUND: Traumatic cervical spinal cord injury is a devastating condition with unpredictable neurological outcomes. American Impairment Scale grade A lesions, particularly those associated with burst fractures, are typically linked to poor recovery. CASE PRESENTATION: A 15-year-old Syrian male presenting with a C5 burst fracture and a 20.2 mm intramedullary lesion (American Impairment Scale grade A) underwent successful plate and cylinder fixation. Following intensive postoperative rehabilitation, the patient demonstrated an exceptional clinical trajectory, transitioning from complete paraplegia and upper-extremity weakness to full functional ambulation and motor recovery within three months (refer to the Graphical Abstract). CONCLUSIONS: This case demonstrates that complete neurological recovery may be achievable in pediatric patients following severe cervical burst fractures and extensive spinal cord contusions, despite an initial American Impairment Scale grade A presentation. The findings suggest that the combination of early surgical stabilization and intensive rehabilitation can optimize outcomes, challenging traditional prognostic expectations for large intramedullary lesions.