Clinical characteristics and proposed mechanism of pediatric spinal cord injury resulting from backbend practice

Frontiers in Pediatrics, 2023 · DOI: 10.3389/fped.2023.1263280 · Published: October 10, 2023

Spinal Cord Injury Pediatrics Rehabilitation

Simple Explanation

This study investigates spinal cord injuries in children caused by backbend exercises, focusing on how the spinal cord and femoral nerve can be overstretched. Researchers analyzed clinical data from young female patients diagnosed with SCIWORA due to backbends. Healthy dancers were recruited to simulate the backbend, allowing the team to measure the stretch on the spinal cord and femoral nerve. An animal model using rats was also used to replicate the injury mechanism. The findings suggest that overstretching both the spinal cord and femoral nerve during backbends can lead to SCIWORA in children. The study also proposes that sudden muscle contractions while attempting a backbend could worsen these injuries.

Study Duration

2017-2021 (data collection)

Participants

42 SCIWORA female patients, healthy dancers, and SD rats

Evidence Level

Original Research

Key Findings

1
The thoracic spinal cord and femoral nerves were overstretched by 148.8 ± 3.6% and 111.7 ± 4.0%, respectively, in a full backbend posture.
2
Most patients had complete paraplegia (76%), and neurological levels were distributed mainly in thoracic segments (91%).
3
Patients with elicited tendon reflexes on admission tended to have an incomplete spinal cord injury and improved motor recovery.

Research Summary

This study investigated the clinical characteristics and proposed mechanism of pediatric spinal cord injury resulting from backbend practice, focusing on the 'combined injury mechanism' related to spinal cord and femoral nerve overstretching. The study found that spinal overstretch and transient dislocation are primary mechanisms for SCIWORA in children, with femoral nerve overstretching aggravating spinal cord injuries from backbend practice. The research suggests that adequate muscle relaxation and adaptation training before backbend exercises can help reduce the occurrence of pediatric SCIWORA.

Practical Implications

Prevention Strategies

Emphasize adequate muscle relaxation and adaptation training before children engage in backbend exercises.

Diagnostic Awareness

Raise awareness among clinicians about backbend-associated SCIWORA, especially in young female dancers, to avoid misdiagnosis.

Rehabilitation Approaches

Tailor rehabilitation programs to address both spinal cord and femoral nerve involvement, considering the potential for synergistic injuries.

Study Limitations

1
The study was conducted using cases from one rehabilitation center and may thus not be generalizable to all populations at risk for this injury.
2
A primate model should be more suitable than the rat model.
3
More pathological and electrophysiological evidence is needed to support our suggestion.

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