Case: A 23-month-old girl with Morquio A syndrome (mucopolysaccharidosis IVA [MPS IVA]) scheduled for atlantoaxial stabilization surgery sustained a cervical spinal cord injury with tetraplegic symptoms following a low-energy fall. Computed tomography (CT) images showed forward translation of C1 over C2 and magnetic resonance imaging (MRI) revealed upper cervical spinal cord injury. An urgent decompression and spinal fusion from C0 to C2 were performed. Postoperative recovery showed significant neurological improvement and at 1-year follow-up, the patient was symptom-free.

Conclusion: This case highlights the risk of severe cervical spinal cord injury following minor trauma in patients with MPS IVA-associated cervical instability and demonstrates the potential for neurological recovery after prompt surgical decompression and stabilization.