Guidelines for management of pediatric acute hyperextension spinal cord injury

Chinese Journal of Traumatology, 2023 · DOI: https://doi.org/10.1016/j.cjtee.2022.07.005 · Published: February 1, 2023

Spinal Cord Injury Pediatrics Rehabilitation

Simple Explanation

This guideline focuses on pediatric acute hyperextension spinal cord injury (PAHSCI), a type of spinal cord injury in children without visible damage on X-rays or CT scans, often linked to back-bending exercises in dance. PAHSCI is becoming a leading cause of spinal cord injuries in children. The guideline provides recommendations for diagnosis, treatment, and prevention, aiming to standardize care for this specific condition. The recommendations address various aspects, including pre-hospital care, physical examinations, auxiliary examinations like MRI, and considerations for treatments such as methylprednisolone.

Study Duration

Not specified

Participants

483 pieces of literature were retrieved

Evidence Level

I-IV

Key Findings

1
PAHSCI is defined as acute thoracolumbar SCI without fracture and dislocation in children after hyperextension of the spine, especially during back-bend in dance training.
2
Epidemiological data indicates that PAHSCI, linked to back-bending in dance, predominantly affects girls aged 3-10 years and has become a leading cause of SCI in children.
3
The guideline suggests that early immobilization and transfer to a specialized hospital are crucial if neurological symptoms occur during spinal hyperextension training.

Research Summary

This guideline addresses pediatric acute hyperextension spinal cord injury (PAHSCI), a distinct type of SCIWORA increasingly prevalent in children, especially those involved in dance. The guideline provides 23 recommendations for 14 related issues, covering prevention, diagnosis, treatment, and management of complications associated with PAHSCI. Recommendations include cautious participation in hyperextension exercises, prompt immobilization upon symptom onset, and comprehensive physical and auxiliary examinations for diagnosis.

Practical Implications

Prevention Strategies

Discouraging thoracic spinal hyperextension exercises, especially for children under 10, and ensuring professional guidance if these exercises are necessary.

Early Intervention

Prompt immobilization and specialized hospital transfer upon neurological symptom onset during hyperextension training, emphasizing 'time is spine' for SCI.

Comprehensive Assessment

Routine spinal X-ray, CT, MRI, and magnetic resonance angiography for accurate PAHSCI diagnosis and spinal cord blood vessel evaluation.

Study Limitations

1
The pathogenesis of PAHSCI is still unclear and controversial.
2
The epidemiology of PAHSCI is still lacking.
3
There is still insufficient evidence to determine whether methylprednisolone is used in the treatment of PAHSCI, and further research is needed.

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