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Newswise — Jacki Page sighed as she buckled her 1-year-old daughter, Evelyn, into the car at the family’s favorite park. Her 2-year-old son, Owen, was king of the playground and, as usual, he didn’t want to abandon his imaginary kingdom yet, initiating their routine of “escape, capture, giggle, repeat.”

Once Jacki had corralled her rambunctious boy, she sent a wry text to her husband, Mitchell: “The worst part about leaving the park is actually leaving the park.”

She couldn’t have known how true that text would become.

Moments after pulling out of the parking lot, Jacki awoke to sirens and crunching metal. She tried to look around, but her head was wedged between the passenger side and Owen’s car seat – she couldn’t see her children, and she couldn’t move.

The Pages would later learn that the driver of an oncoming car had suffered a medical event, lost control, and slammed into Jacki’s car at 70 mph. The point of impact was Owen’s seat.

Somehow, Evelyn sustained only minor bruises. Owen was ejected from the vehicle and incurred major injuries to his head and neck. Jacki, unable to feel anything from the chest down, was rushed to a hospital in Plano.

Her two children were transported to Children’s Medical Center Dallas, a Level 1 trauma center where UT Southwestern pediatric neurosurgeon Bruno Braga, M.D., would not only save her son’s life but also give him a chance to once again become king of the playground.

‘We’re going to take you to see your son’Mitchell Page was a fourth-grade teacher at the time of the accident in September 2022, and he was herding his class indoors after recess when he noticed the missed calls and texts.

“Reception is poor on the playground,” Mitchell said. “When I called back, they gave me the news: ‘Your wife and kids were in a car accident.’”

Mitchell took off for the hospital in Plano, but on the way, he received another call that the kids had been taken to Dallas, so he asked his father to be with Jacki and headed for Children’s Health. He saw Evelyn first and felt a wave of momentary relief because she was shaken up but only bruised. Then a nurse took his arm and said, “We’re going to take you to see your son.”

Mitchell, who prides himself on remaining calm in emergencies, was panicking inside.

“There were dozens of providers in and around the room,” he said. “Owen didn’t have a scratch or bruise on him, but he was unconscious and connected to what seemed like every tube in the world.”

Dr. Braga took him aside and explained that Owen had suffered two significant injuries to his cervical spine: one in the atlanto-occipital joint, between the skull and the first vertebra (C1), and another in the atlanto-axial segment, between vertebrae C1 and C2, causing spinal dislocation and spinal cord injury, as he was not able to move the left side of his body.

Owen’s skull was internally separated from his spine, an injury known as atlanto-occipital dislocation (AOD) that is frequently fatal. If a patient survives, there is a high risk of permanent neurological disability and paralysis. AOD occurs in just 1% of acute cervical , but it is the most common type reported in motor vehicle deaths and three times more common in children than in adults.

Dr. Braga said Owen would need emergency surgery to realign his spine, put the broken pieces back together, and fuse his skull to his spine – internal occipitocervical fixation and fusion surgery.

Owen’s left side was paralyzed, and with every minute that passed, his chances of a positive outcome decreased. Mitchell’s mind raced as he agreed to the procedure.

Then his thoughts shifted: How would he break this news to Jacki?

Racing against the clock

In cases of severe AOD, gravity causes the weight of the body to continuously pull it away from the skull.

“Just trying to move Owen to the operating room or suction his airways were intense, delicate maneuvers,” Dr. Braga said. “It’s so sensitive that, if it were possible, I wouldn’t even let anyone blink at these patients before surgery.”

His team would use a piece of equipment nicknamed the “bed sandwich” to move Owen from his bed to the operating room without further disturbing his spinal cord. Owen was given a paralytic IV medication so he wouldn’t make any unexpected movements, and then pins were placed on his skull to hold his head and neck still.

A body-sized cushion was positioned on top of Owen, as if he were the filling between two slices of bread. Slowly and carefully, the team rotated Owen 180 degrees until he was face down for the surgery.

The goal of surgery, Dr. Braga said, was to save Owen’s life by compressing his head toward his vertebrae and undoing the distracting forces acting on the spinal cord and brainstem, reinforcing the spine to hold the skull, and restoring function to his head, neck, and left side.

Dr. Braga used X-ray guidance to continually realign the angles of Owen’s skull to his neck for a natural posture and to avoid damage to his spinal column and the vertebral arteries that move blood between the heart and brain.

Toddlers have small bones, and the spinal column is narrow. To access enough bone for the fusion, the surgical team had to expose several levels of Owen’s skull and spine. Dr. Braga created a 2-inch incision at the base of Owen’s skull. He also opened an area of Owen’s chest to retrieve segments of his ribs, which would be grafted into the spaces between the damaged vertebrae.

Dr. Braga reattached Owen’s skull to his C1 and C2 vertebrae using a plate secured with surgical screws sunk into the skull 6 millimeters deep and then deepened by 2-mm increments until the plate was properly positioned. In the cervical spine, screws were 20 to 26 mm deep into the vertebrae. The skull and cervical screws served as anchor points for implanted rods that extended across the injured segments.

The surgical team then tightened the hardware, which will stay in Owen’s neck forever. Dr. Braga then placed the rib pieces between the skull, C1, and C2. Over time, the bone grafts, skull, and cervical vertebrae will fuse into one long bone that holds everything in place.

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Putting her children first

After Owen was taken into surgery, Mitchell drove to Plano to see Jacki. A doctor explained she had suffered a T1-T4 spinal fracture (upper spine) and a complete spinal cord injury. Surgery to clear loose bone fragments and damaged tissue had been successful, but Jacki learned she would never walk again.

“The CT scan of her spine looked like shards of glass stuck in a rope of licorice,” Mitchell said. “I was so thankful that she would live. And as difficult as it was to hear that she was a paraplegic, I knew that telling her about Owen was going to be 10 times harder.”

The children were the first thing she asked about when she locked eyes with her husband.

He reassured Jacki that Evelyn was fine. Then he explained Owen’s injury and the surgery Dr. Braga was performing on their son.

Jacki had been a respiratory therapist and had worked in emergency settings; when Mitchell told her Owen’s injury was an AOD, she tried to remain optimistic, but she knew the odds. “It’s internal decapitation,” she texted Mitchell as he got back to Dallas to await word on Owen. “If he lives, he’ll be on a ventilator forever and he’ll never walk or talk again.”

That’s when, Mitchell said, he “lost it in the waiting room.”

A few hours later, Dr. Braga came out of the OR to tell Mitchell and his parents that the eight-hour surgery had been successful. He showed Mitchell a CT scan of Owen’s vertebrae.

“Compared to Jacki’s,” Mitchell said, “it looked like a masterpiece. Completely clear of shards, with the spinal segments where they should be. That was the first time I felt a glimmer of hope.”

Owen's road to recovery

Recovery from spinal surgery is a process – especially for a rowdy toddler. Owen’s  began right after he awoke from surgery. He couldn’t move his left arm or leg, and because he had a feeding tube, he couldn’t speak.

But there was one thing Owen could do: Play.

Pediatric neurological rehab involves a series of intricate exercises disguised as games. After a week in intensive care, Owen began working with Children’s Health physical and occupational therapists Brady Dubose, PT, DPT, and Kristen Killeavy, OT.

“He was consistently interested in playing with the cars and the racetrack we have in one of our gyms,” Killeavy said. “We’d place the cars away and ask him to retrieve them, or we’d set the racetrack up on a higher surface so he’d have to stand to play with it.”

Owen wore a neck brace at all times during his sessions, along with a gait belt to help his therapist hold him upright and guide his path. They’d play games focused on dexterity and cognition, such as:

• Grabbing a specific color of toy car
• Placing oversized coins into the slot of a piggy bank
• Bouncing a ball to knock over pins

“He was able to follow all their directions, and that put me at ease a bit,” Mitchell said.

Within a month, Owen was riding a tricycle up and down the halls of the hospital. He started to gain more freedom in the sensory gym, a therapy playground equipped with padded climbing and hanging equipment, swings, slides, and uneven surfaces so kids can practice all forms of movement.

“Owen was very impulsive, as many toddlers are,” Dubose remembered. “We were still working on his mobility skills and balance when it was almost time for him to go home, and playing in the gym helped him learn safe ways to navigate his daily movements.”

Like mother, like son

At the same time, Jacki was going through her own physical and occupational therapy in Plano.

“My rehab began right after surgery, when my pain was still quite intense,” Jacki said. “But I went to every therapy session – there was no choice not to. I had two babies, and I was going to do whatever I had to so I could get home to them.”

Fueled by support from her sisters – and a daily coffee delivery from her dad – Jacki spent six days in the ICU and more than 40 days in inpatient rehab, adjusting to life as a wheelchair user.

Jacki and Owen spent 50 days apart. So, it was extra special when they were discharged from their respective hospitals on the same day.

“Mitchell picked me up and took me straight to Children’s Health. When Owen came out, he hugged me right away,” Jacki said. “I was so happy to see him walking with my own eyes. That was one of the greatest days.”

Fearless, focused, and full of joy

If you met Owen today, you’d never guess how precarious his situation was just two years ago. He’s an active preschooler who runs and jumps around the playground like a typical now 5-year-old. He does have a scar on the back of his neck, and just below the surface, you can feel the surgical screws in the back of his head – a wonder he loves to show his friends.

“His teachers say he is the most affectionate kid,” Jacki said. “Anytime someone gets hurt, he is the first one to give them a hug and check on them.”

Owen will have to be careful about his health, and contact sports are off the table. He’s not expected to need follow-up surgery, but routine X-rays will make sure there is no abnormal bone or tissue growth in the cervical spine.

The hardest thing for Owen is that he’s always on the go and a little fearless, which is especially tough on his parents. Every time they pick him up from school, he’s at the top of the play structure – waving before he slides down to head back to the family’s home in Rowlett.

Mitchell says Owen gets his fearlessness from Jacki, who has also returned to school, taking online college courses through UT Arlington for a new career in public health. With two busy preschoolers, a college degree in progress, and regular follow-up medical visits, there’s never a dull moment in the Page household.

“The other day, I was sitting at the table doing my homework, and I saw Owen walk very confidently past me, holding a stepstool,” Jacki said. “He informed me that he and Evelyn were playing space astronauts and pirates, and he needed to jump off the stepstool into the pretend water to fight the sharks.”

King of the playground, indeed.

Not a day goes by that the Pages don’t count their blessings.

“Owen is here to do whatever he is supposed to do in this world,” Mitchell said. “While I am eternally grateful to our Lord and Savior, Dr. Braga is a very, very close second.”