Skip to main content

Advertisement

SpringerLink
Log in

Pediatric thoracic SCIWORA after back bend during dance practice: a retrospective case series and analysis of trauma mechanisms

  • Original Paper
  • Published:
Child's Nervous System Aims and scope Submit manuscript

A Commentary to this article was published on 03 June 2017

Abstract

Purpose

The purpose of the study was to describe a unique type of low-energy traumatic pediatric thoracic spinal cord injury without radiographic abnormality (SCIWORA) after a back bend during dance practice and analyze the trauma mechanisms and treatment protocols.

Methods

This was a retrospective case series from September 2007 to August 2016. The study was conducted at a tertiary medical center in Beijing, China (Xuanwu Hospital, China International Neuroscience Institute [China-INI], Capital Medical University). A total of 12 pediatric patients who had a clear traumatic history after back bend movements and had been diagnosed with thoracic SCIWORA were included. Clinical and imaging data were obtained for each patient. The follow-up data was analyzed. The traumatic mechanisms were investigated by analyzing the patients’ medical history, spinal diffusion tensor imaging (DTI) and fiber tractography data.

Results

Of the 12 patients, 11 (91.7%) were younger than 8 years old. The mean age of the patients was 6.6 years. All patients had a clear traumatic history of severe thoracic spinal cord injury after performing back bend movements. The mean follow-up time was 36.5 months. During the follow-up period, 1 patient (8.3%) recovered completely, and 11 patients (91.7%) had unfavorable prognoses, including 4 (33.3%) with incomplete recovery and 7 (58.3%) with no change. Two patients underwent spinal DTI, which showed rupture of the nerve fiber bundle in the section of the injury.

Conclusions

Back bend movements performed during dance practice may cause pediatric thoracic SCIWORA, particularly in children younger than 8 years old. We suggest that the mechanism of primary injury is the longitudinal distraction of the thoracic spine during back bend movements, which leads to violent distraction of the spinal cord and blunt injury of nerve axons, nerve cells, and small vessels. Spinal DTI may facilitate the diagnosis and prognostic evaluation of SCIWORA.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Log in via an institution

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Fig. 1
Fig. 2
Fig. 3
Fig. 4
Fig. 5

Similar content being viewed by others

Abbreviations

SCIWORA:

Spinal cord injury without radiographic abnormality

MRI:

Magnetic resonance imaging

CT:

Computed tomography

DTI:

Diffusion tensor imaging

ASIA:

The American Spinal Injury Association.

References

  1. Pang D, Wilberger JE Jr (1982) Spinal cord injury without radiographic abnormalities in children. J Neurosurg 57(1):114–129. doi:10.3171/jns.1982.57.1.0114

    Article  CAS  PubMed  Google Scholar 

  2. Szwedowski D, Walecki J (2014) Spinal cord injury without radiographic abnormality (SCIWORA)—clinical and radiological aspects. Pol J Radiol 79:461–464. doi:10.12659/PJR.890944

    Article  PubMed  PubMed Central  Google Scholar 

  3. Pang D (2004) Spinal cord injury without radiographic abnormality in children, 2 decades later. Neurosurgery 55:1325–1342 . doi:10.1227/01.NEU.0000143030.85589.E6discussion 1342

    Article  PubMed  Google Scholar 

  4. Carroll T, Smith CD, Liu X et al (2015) Spinal cord injuries without radiologic abnormality in children: a systematic review. Spinal Cord 53(12):842–848. doi:10.1038/sc.2015.110

    Article  CAS  PubMed  Google Scholar 

  5. Burke DC (1974) Traumatic spinal paralysis in children. Paraplegia 11(4):268–276. doi:10.1038/sc.1973.39

    Article  CAS  PubMed  Google Scholar 

  6. Piatt JH (2015) Pediatric spinal injury in the US: epidemiology and disparities. J Neurosurg—Pediatr 16(4):463–471. doi:10.3171/2015.2.PEDS1515

    PubMed  Google Scholar 

  7. Hendey GW, Wolfson AB, Mower WR, Hoffman JR, National Emergency X-Radiography Utilization Study Group (2002) Spinal cord injury without radiographic abnormality: results of the National Emergency X-Radiography Utilization Study in blunt cervical trauma. J Trauma 53(1):1–4. doi:10.1097/00005373-200207000-00001

    Article  PubMed  Google Scholar 

  8. Robles LA (2007) Traumatic spinal cord infarction in a child: case report and review of literature. Surg Neurol 67(5):529–534. doi:10.1016/j.surneu.2006.07.016

    Article  PubMed  Google Scholar 

  9. Pang D, Pollack IF (1989) Spinal cord injury without radiographic abnormality in children—the SCIWORA syndrome. J Trauma 29(5):654–664. doi:10.1097/00005373-198905000-00021

    Article  CAS  PubMed  Google Scholar 

  10. Walsh JW, Stevens DB, Young AB (1983) Traumatic paraplegia in children without contiguous spinal fracture or dislocation. Neurosurgery 12(4):439–445. doi:10.1227/00006123-198304000-00012

    Article  CAS  PubMed  Google Scholar 

  11. Cheshire DJ (1977) The paediatric syndrome of traumatic myelopathy without demonstrable vertebral injury. Paraplegia 15(1):74–85. doi:10.1038/sc.1977.11

    Article  CAS  PubMed  Google Scholar 

  12. Riviello JJ Jr, Marks HG, Faerber EN, Steg NL (1990) Delayed cervical central cord syndrome after trivial trauma. Pediatr Emerg Care 6(2):113–117. doi:10.1097/00006565-199006000-00012

    Article  PubMed  Google Scholar 

  13. Yamaguchi S, Hida K, Akino M, Yano S, Saito H, Iwasaki Y (2002) A case of pediatric thoracic SCIWORA following minor trauma. Childs Nerv Syst 18(5):241–243. doi:10.1007/s00381-002-0560-9

    Article  PubMed  Google Scholar 

  14. Shen H, Tang Y, Huang L et al (2007) Applications of diffusion-weighted MRI in thoracic spinal cord injury without radiographic abnormality. Int Orthop 31(3):375–383. doi:10.1007/s00264-006-0175-y

    Article  PubMed  Google Scholar 

  15. Wang YJ, Zhou HJ, Wei B et al (2016) Clinical characteristics analysis of 120 cases of pediatric spinal cord injury without radiologic abnormality. Zhonghua Yi Xue Za Zhi 96(2):122–125. doi:10.3760/cma.j.issn.0376-2491.2016.02.010

    CAS  PubMed  Google Scholar 

  16. McDonald JW, Sadowsky C (2002) Spinal-cord injury. Lancet 359(9304):417–425. doi:10.1016/S0140-6736(02)07603-1

    Article  PubMed  Google Scholar 

  17. Paleologos TS, Fratzoglou MM, Papadopoulos SS, Chatzidakis EE, Gouliamos AD, Kourousis DD (1998) Posttraumatic spinal cord lesions without skeletal or discal and ligamentous abnormalities: the role of MR imaging. J Spinal Disord 11(4):346–349

    CAS  PubMed  Google Scholar 

  18. Schneider RC, Cherry G, Pantek H (1954) The syndrome of acute central cervical spinal cord injury; with special reference to the mechanisms involved in hyperextension injuries of cervical spine. J Neurosurg 11(6):546–577. doi:10.3171/jns.1954.11.6.0546

    Article  CAS  PubMed  Google Scholar 

  19. Leventhal HR (1960) Birth injuries of the spinal cord. J Pediatr 56:447–453. doi:10.1016/S0022-3476(60)80356-3

    Article  CAS  PubMed  Google Scholar 

  20. Kwon BK, Tetzlaff W, Grauer JN, Beiner J, Vaccaro AR (2004) Pathophysiology and pharmacologic treatment of acute spinal cord injury. Spine J 4(4):451–464. doi:10.1016/j.spinee.2003.07.007

    Article  PubMed  Google Scholar 

  21. Carreon LY, Glassman SD, Campbell MJ (2004) Pediatric spine fractures: a review of 137 hospital admissions. J Spinal Disord Tech 17(6):477–482. doi:10.1097/01.bsd.0000132290.50455.99

    Article  PubMed  Google Scholar 

  22. Eleraky MA, Theodore N, Adams M, Rekate HL, Sonntag VK (2000) Pediatric cervical spine injuries: report of 102 cases and review of the literature. J Neurosurg 92(1 Suppl):12–17. doi:10.3171/spi.2000.92.1.0012

    CAS  PubMed  Google Scholar 

  23. Hamilton MG, Myles ST (1992) Pediatric spinal injury: review of 174 hospital admissions. J Neurosurg 77(5):700–704. doi:10.3171/jns.1992.77.5.0700

    Article  CAS  PubMed  Google Scholar 

  24. Zwimpfer TJ, Bernstein M (1990) Spinal cord concussion. J Neurosurg 72(6):894–900. doi:10.3171/jns.1990.72.6.0894

    Article  CAS  PubMed  Google Scholar 

  25. Tator CH, Koyanagi I (1997) Vascular mechanisms in the pathophysiology of human spinal cord injury. J Neurosurg 86(3):483–492. doi:10.3171/jns.1997.86.3.0483

    Article  CAS  PubMed  Google Scholar 

  26. Atkinson PP, Atkinson JL (1996) Spinal shock. Mayo Clin Proc 71(4):384–389. doi:10.1016/S0025-6196(11)64067-6

    Article  CAS  PubMed  Google Scholar 

  27. Sąsiadek MJ, Szewczyk P, Bladowska J (2012) Application of diffusion tensor imaging (DTI) in pathological changes of the spinal cord. Med Sci Monit 18(6):RA73–RA79. doi:10.12659/MSM.882891

    PubMed  PubMed Central  Google Scholar 

  28. Sąsiadek M, Szewczyk P (2009) Imaging of the spine: new possibilities and its role in planning and monitoring therapy. Pol J Radiol 74:52–58

    Google Scholar 

  29. Thurnher MM, Law M (2009) Diffusion-weighted imaging, diffusion-tensor imaging, and fiber tractography of the spinal cord. Magn Reson Imaging Clin N Am 17(2):225–244. doi:10.1016/j.mric.2009.02.004

    Article  PubMed  Google Scholar 

  30. Maier SE, Mamata H (2005) Diffusion tensor imaging of the spinal cord. Ann N Y Acad Sci 1064:50–60. doi:10.1196/annals.1340.011

    Article  PubMed  Google Scholar 

  31. Shanmuganathan K, Gullapalli RP, Zhuo J, Mirvis SE (2008) Diffusion tensor MR imaging in cervical spine trauma. AJNR Am J Neuroradiol 29(4):655–659. doi:10.3174/ajnr.A0916

    Article  CAS  PubMed  Google Scholar 

  32. Bozzo A, Marcoux J, Radhakrishna M, Pelletier J, Goulet B (2011) The role of magnetic resonance imaging in the management of acute spinal cord injury. J Neurotrauma 28(8):1401–1411. doi:10.1089/neu.2009.1236

    Article  PubMed  PubMed Central  Google Scholar 

  33. Bracken MB, Shepard MJ, Collins WF et al (1990) A randomized, controlled trial of methylprednisolone or naloxone in the treatment of acute spinal-cord injury. Results of the Second National Acute Spinal Cord Injury Study. N Engl J Med 322(20):1405–1411. doi:10.1056/NEJM199005173222001

    Article  CAS  PubMed  Google Scholar 

  34. Bracken MB, Shepard MJ, Holford TR et al (1997) Administration of methylprednisolone for 24 or 48 hours or tirilazad mesylate for 48 hours in the treatment of acute spinal cord injury. Results of the third national Acute Spinal Cord Injury Randomized Controlled Trial. National Acute Spinal Cord Injury Study JAMA 277(20):1597–1604. doi:10.1001/jama.277.20.1597

    CAS  PubMed  Google Scholar 

  35. Hugenholtz H (2003) Methylprednisolone for acute spinal cord injury: not a standard of care. CMAJ 168(9):1145–1146

    PubMed  PubMed Central  Google Scholar 

  36. Pettiford JN, Bikhchandani J, Ostlie DJ, St Peter SD, Sharp RJ, Juang D (2012) A review: the role of high dose methylprednisolone in spinal cord trauma in children. Pediatr Surg Int 28(3):287–294. doi:10.1007/s00383-011-3012-3

    Article  PubMed  Google Scholar 

Download references

Acknowledgements

This study was supported by the National Natural Science Foundation of China (81671202) and the National Natural Science Foundation of China (81271556).

Author information

Author notes

  1. Jian Ren and Gao Zeng have contributed equally and should be considered co-first authors.

Authors and Affiliations

  1. Department of Neurosurgery, Xuanwu Hospital, Capital Medical University, China International Neuroscience Institute (China-INI), Beijing, 100053, China

    Jian Ren, Gao Zeng, Yong-jie Ma, Zan Chen, Feng Ling & Hong-qi Zhang

  2. Department of Radiology, Xuanwu Hospital, Capital Medical University, Beijing, 100053, China

    Nan Chen

Authors
  1. Jian Ren
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Gao Zeng
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. Yong-jie Ma
    View author publications

    You can also search for this author in PubMed Google Scholar

  4. Nan Chen
    View author publications

    You can also search for this author in PubMed Google Scholar

  5. Zan Chen
    View author publications

    You can also search for this author in PubMed Google Scholar

  6. Feng Ling
    View author publications

    You can also search for this author in PubMed Google Scholar

  7. Hong-qi Zhang
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to Hong-qi Zhang.

Ethics declarations

This work was approved by the local ethics board of our institution.

Conflict of interest

None.

Ethical approval

For this type of study, formal consent is not required.

Rights and permissions

Reprints and permissions

About this article

Check for updates. Verify currency and authenticity via CrossMark

Cite this article

Ren, J., Zeng, G., Ma, Yj. et al. Pediatric thoracic SCIWORA after back bend during dance practice: a retrospective case series and analysis of trauma mechanisms. Childs Nerv Syst 33, 1191–1198 (2017). https://doi.org/10.1007/s00381-017-3407-0

Download citation

  • Received:

  • Accepted:

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s00381-017-3407-0

Keywords

Search

Navigation