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INNOSC Theranostics and
Pharmacological Sciences Hyperextension spine injury in children

Table 1. The distribution of intramedullary lesion length with high‑intensity signal based on MRI
Number of vertebral levels with high‑intensity signal based on MRI
0 1 2 3 4 5 6 7 8 9 10 11 12 13 14 17
Complete injury 0 0 1 3 5 5 10 19 15 9 9 13 7 5 4 1
Incomplete injury 4 0 3 0 9 11 18 24 22 10 10 15 0 6 0 0
Notes: Complete injury: ASIA grade A; Incomplete injury: ASIA grades B, C, and D. Data used to derive this table is taken from reference. 8-10
Abbreviation: MRI: Magnetic resource imaging.

Table 2. ASIA grades during initial and final follow‑up

ASIA grades during initial follow‑up ASIA grades during final
follow‑up and number
of cases
ASIA Number of cases during A B C D E
grade initial follow‑up
Grade A 104 101 2 1 0 0
Grade B 26 0 11 6 7 2
Grade C 7 0 0 2 4 1
Grade D 7 0 0 0 6 1
Note: Data used to derive this table are taken from reference. 8-10
Abbreviation: ASIA: American Spinal Injury Association. Figure 2. The distribution of neurological level of spinal cord injury. Data
used to derive this figure are taken from reference. 8-10
angiography remains the gold-standard technique for
confirming and predicting the prognosis of repetitive
hyperextension-induced SCI.
After confirming the diagnosis and assessing the
severity of the injury, it is crucial to monitor the patient’s
vital signs. Conservative treatment can yield significant
results in stable cases but may not improve the condition
in unstable cases. Overall, the prognosis of SCI depends on
the severity of the initial injury, the timing and accuracy
of diagnosis, and the implementation of appropriate
treatment. 15-17 At present, a limited range of therapeutic
treatments is available for both adults and children affected
by SCI, and the lack of treatment would lead to severe Figure 3. The extent of spinal cord atrophy. Data used to derive this figure
and persistent neurological abnormalities and disabilities are taken from reference. 8-10
that can persist for decades until death. 15-17 Therefore,
to expand the variety of SCI treatments for children, spine movements may lead to SCI. Furthermore, they
further and extensive research is required. Badhiwala et should take careful measures to protect the children
al. advocate that “time is the spine,” but whether early and prevent accidental injuries during training
surgical intervention is necessary for this specific SCI is sessions that involve hyperextension movements
still unknown. Therefore, preventing SCI during dance 3. At the time of injury, training should be stopped
16
training is currently the best feasible strategy. immediately, and children should be immobilized and
According to the literature, we propose the following placed in a supine resting position to prevent injury
several recommendations on the management and deterioration and the occurrence of secondary injury.
prevention of SCI for children engaging in backbend Medical help should be sought immediately if any
dance: neurological symptoms appear
1. Children under the age of 10 should refrain from 4. The potential occurrence of SCI due to backbend
practicing spine hyperextension movements dance should be brought to the attention of the
2. Coaches and parents of children participating in general public, guardians, sports institutions, and
hyperextension activities should be informed that these education departments, as part of the awareness-

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