Hadassah surgeons reattach boy’s head to his neck after internal decapitation
Suleiman, 12, who was hit by a car while riding his bicycle, undergoes extremely rare operation after his ligaments were broken, base of skull severed from spine’s top vertebra
Suleiman Hassan, a Palestinian from the West Bank, was airlifted to Hadassah hospital’s trauma unit in Ein Kerem, where it was determined that the ligaments holding the posterior base of his skull were severely damaged, leaving it detached from the top vertebrae of his spine. The condition, bilateral atlanto occipital joint dislocation, is commonly known as internal or orthopedic decapitation.
The injury is very rare in adults, and even more so in children.
“We fought for the boy’s life,” said Dr. Ohad Einav, the orthopedic specialist who operated on the patient together with Dr. Ziv Asa and a large operating room and intensive care team. The surgery was carried out in early June.
“The procedure itself is very complicated and took several hours. While in the operating room, we used new plates and fixations in the damaged area… Our ability to save the child was thanks to our knowledge and the most innovative technology in the operating room,” Einav said.
“The procedure itself is very complicated and took several hours. While in the operating room, we used new plates and fixations in the damaged area… Our ability to save the child was thanks to our knowledge and the most innovative technology in the operating room,” Einav said.
Einav, who returned to Israel a year ago after a fellowship at trauma centers in Toronto, estimated that this rare injury has occurred in Israel before. As far as he is aware, he is one of just a few surgeons in Israel who specialize in trauma surgery for spinal injuries.
Hassan was recently discharged home with a cervical splint and will continue to be carefully monitored by the Hadassah staff.
“The fact that such a child has no neurological deficits or sensory or motor dysfunction, and that he is functioning normally and walking without an aid after such a long process, is no small thing,” Einav said.
A Children’s Hospital of Philadelphia report from 2003 stated that of the 2006 patients it treated for spinal cord injuries between 1983 and 2003, only 16 suffered from occipital joint dislocation.
“The injury is extremely rare, but we do know that because children between ages four and 10 have heads that are large in relation to their bodies, they are more susceptible than adults,” Einav said.
The survival rate of those who suffer internal decapitation is low. In most cases, the injury results in death. There is evidence that children fare better than adults, but there is not yet enough data comparing children to adolescents.
A 2021 survey of studies on the injury in children and adolescents found that 55% do not survive the initial injury, transport to the hospital, surgery, and recovery.
The hospital reported that Hassan’s father did not leave his bedside during his recovery from surgery.
“I will thank you all my life for saving my dear only son. Bless you all. Thanks to you he regained his life even when the odds were low and the danger was obvious. What saved him were professionalism, technology and quick decision-making by the trauma and orthopedics team. All I can say is a big thank you,” he told the medical staff.
Einav said that his having performed this surgery on adults as part of his training in Toronto prepared him to operate on young Hassan.
“This is not a common surgery at all, and especially not on children and teens. A surgeon needs knowledge and experience to do this,” he said.
Posted by: Chief Mac, 9th July 2023
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