Page 117 - ITPS-7-3

INNOSC Theranostics and
Pharmacological Sciences Hyperextension spine injury in children

incidence of SCI in children is 8 – 13/million annually. To dance training to paraplegia, no interventional approaches
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date, much of the management and treatment of pediatric or effective treatments were implemented, such as training
SCI has been extrapolated from the adult literature, given cessation, immobilization or supine rest, and early medical
the low incidence of pediatric SCI and the limited number treatment. However, no obvious fractures or dislocations
of cases in children. 4 were found in the imaging examination after the injury. Only

China has a significant number of SCI cases. However, magnetic resonance imaging (MRI) showed a longitudinally
there is no national or regional SCI registry system in diffuse intramedullary high-intensity signal and spinal cord
China. As a result, the incidence of SCI in all age groups, edema, while the extent of edema was not consistent with
especially among children, remains unclear. Public the neurological level of injury (Table 1 and Figure 2). The
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education, improved safety features in motor vehicles, final follow-up showed poor prognosis in patients with
and the stricter enforcement of seat belt laws, driving- complete SCI (American Spinal Injury Association [ASIA]
under-the-influence regulations, protection of minors, grade A) 8-10 (Table 2). The final follow-up MRI conducted
and prohibition of child labor may have contributed to a 1 – 4 months after intervention showed distal spinal cord
decline in SCI rates among children. In China, the number atrophy (Figure 3). Moreover, the long-term follow-up also
of SCIs in children caused by backbend movements during revealed that the patients with complete SCI were grappling
dance training is increasing and accounts for 50% of all with serious complications, such as scoliosis, hip dysplasia
SCIs in children in the past two decades. SCI caused by or dislocation, bedsore, urinary tract infection, lower limb
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these movements, which have been left unaddressed and neurogenic fracture, and muscle atrophy. 1,10
unresearched for a long time, brings a heavy psychological
and economic burden to children and their families. 3. Practical implications
With the continued enhancement of health consciousness,
2. Case studies and findings many children are becoming involved in recreational
More than 200 cases of SCI have been reported in China activities, such as yoga, gymnastics, ballet, cheerleading,
over the past 5 years. 8-11 In this paper, we reviewed the acrobatics, pilates, backbends, surfing, and swimming,
data gathered from six articles, which included 144 which often entail a certain degree of risk to continuous
Chinese children with SCI that happened after repetitive spine hyperextension movements. However, SCI resulting
hyperextension movement (backbend movements) during from backbend dance remains largely neglected by the
dance training. 8-10 Other cases of SCI that was not related public, dance training institutions, as well as sports centers
to repetitive hyperextension movement were excluded. in China. 8-11 Such negligence will not put a halt to the
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Almost all of the cases occurred in young girls under occurrence of SCI due to hyperextension movement. At
11 years old. The age distribution of this injury ranges from present, there are no relevant recommendations to prevent
3 to 11 years old (Figure 1), and 99% of cases were under SCI occurrence in children during dance training.
10 years old with an average age of 6 ± 2 years. All of them According to China’s seventh census, there are more than
presented hyperacute onset of SCI within the first 4 h after 250 million children aged 0 – 14 in the country, accounting
the injury, and many cases showed no symptoms during for 17.95% of the total national population. Following a
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the first few minutes after injury. However, during the shift to China’s fertility policy – replacement of the one-
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incubation period (15 min to 4 h) from accidental injury in child policy with the three-child policy – expectedly China
will usher in a new round of baby boom, which potentially
increase the proportion of children population. At the same
time, as part of the government’s education reform efforts,
measures are being taken to reduce the excessive burden of
homework and after-school tutoring for primary and middle
school students. The policy change and the implementation
of new homework burden-lessening measures would spur
the increased participation of children in recreational
activities, which will inevitably raise the incidence of SCI
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in this young-age population.
Wang et al. hypothesized that the effect of internal
organs on the inferior vena cava may lead to impaired
Figure 1. The age distribution of spinal cord injury after hyperextension blood perfusion, primarily at the T9-T10 level, ultimately
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movement. Data used to derive this figure are taken from reference. 8-10 resulting in ischemic SCI. At present, magnetic resonance

Volume 7 Issue 3 (2024) 2 doi: 10.36922/itps.3460