In early June 2023, Suleiman Hassan, a 12-year-old Palestinian boy from the West Bank, was airlifted to Hadassah Medical Center’s trauma unit in Ein Kerem, Jerusalem 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.

In an extremely rare and highly complex operation, two Israeli surgeons along with a large operating room and intensive care team have managed to reattach Hassan’s head to his neck after the boy was hit by a car while riding his bicycle.

“We fought for the boy’s life,” Dr. Ohad Einav, the orthopaedic specialist who operated on the patient together with Dr. Ziv Asa, told The Times Of Israel. The surgery was carried out in early June but only announced by the Jerusalem hospital on Wednesday 5 July.

“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.

Internal decapitation is an extremely rare injury which occurs when a sudden impact causes the ligaments and muscles holding the head to the top vertebrae of the spine to tear. Doctors said the boy’s head had “almost completely detached from the base of his neck,” but thankfully, the skin and major blood vessels remained intact.

The injury is treated by fusing the skull and spinal column together using rods, screws, plates and possibly bone grafts. Einav, who has been back in Israel for a year after a fellowship in Toronto working in trauma centres, reckons that this isn’t the first time such an incident has occurred in the country. As far as he is aware, he is one of just a few surgeons who specialise in the field of trauma surgery for spinal injuries.

Suleiman’s father, who didn’t leave his son’s bedside during his recovery from surgery, said: “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 orthopaedics team. All I can say is a big thank you.”

The young boy was recently discharged home with a cervical splint and will continue to be carefully monitored by the hospital 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 noted.

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.