Figure - available from: Frontiers in Pediatrics
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Radiological images showing spina bifida occulta. (a) Sacral 1 spina bifida occulta. (b) Fatty filum terminale. (c–e) are from the same patient. (c) Sacral lumbarization and Lumbar 6 spina bifida occulta. (d) Sacral 1 spina bifida occulta. (e) Sacral 2 spina bifida occulta.
Source publication
Objective
This study aimed to explore the clinical features and outcomes of children with spinal cord injury (SCI) without fracture or dislocation.Methods
The clinical data of children with SCI without fracture or dislocation in this retrospective study were collected in Chongqing, China (January 2010 to December 2021). We collected patient demogra...
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Common and minor birth defects, such as spina bifida occulta (SBO) and lumbosacral transitional vertebra (LSTV), are largely asymptomatic and overlooked. However, it is important for clinicians to consider their potential impacts on spinal stability. Neuromuscular scoliosis (NMS) is an abnormal lateral curvature of the spine that affects children w...
Citations
... However, this action can cause severe spinal cord injury without radiographic abnormality (SCIWORA), particularly among female children (2). In China, the incidence of pediatric SCIWORA due to dance has increased by 6.2% in sports injury in recent years (3)(4)(5)(6). ...
... The suggested mechanism for SCIWORA caused by both violent events and backbend practices is that excessive stretching of the spine and spinal cord causes longitudinal spinal distraction injury and/or transient spinal dislocation (1). Other suggested mechanisms for the SCI caused by backbend include anatomy abnormalities, such as occult vasculopathy, spinal cord malformations, and tight filum terminale (2,5,14). ...
Objective
Pediatric spinal cord injury without radiographic abnormality (SCIWORA) caused by backbend practice is increasing. This study proposed an underlying ‘combined injury mechanism’ related to the spinal cord and femoral nerve overstretching.
Methods
Pediatric patients diagnosed with backbend-associated SCIWORA at the China Rehabilitation Research Center during 2017–2021 were recruited. Clinical and imaging data were collected, and each patient's clinical course and prognosis were determined. Healthy dancers were recruited to simulate the backbend, obtain images, and estimate the spinal cord and femoral nerve stretch ratio. A model for the ‘combined injury mechanism’ was established using 4-week-old SD rats.
Results
Forty-two SCIWORA female patients with an average age of 6 (SD 1) years and an average hospitalization time of 91 (SD 43) days were assessed. The primary initial symptom was pain in the back and/or lower extremities (33, 79%). The average time from injury onset to severe paralysis was 2.0 (SD 0.6) hours. Most patients had complete paraplegia (32, 76%), and neurological levels were distributed mainly in thoracic segments (38, 91%). Patients with elicited tendon reflexes on admission tended to have an incomplete spinal cord injury ( p = 0.001) and improved motor recovery ( p = 0.018). After one year, the most common complications were scoliosis (31, 74%) and abnormal hips (14, 33%). Injury of the caudal spinal cord torn by nerve roots was confirmed by surgical exploration in a case. The thoracic spinal cord and femoral nerves were overstretched by 148.8 ± 3.6% and111.7 ± 4.0%, respectively, in a full backbend posture. The ‘combined injury mechanism’ was partially replicated in the animal model.
Conclusion
Spinal overstretch and transient dislocation are considered the primary mechanisms by which SCIWORA occurs in children. Overstretching the femoral nerve aggravates spinal cord injuries caused by backbend practice.
Background:
Backbend-induced pediatric thoracic spinal cord injury without radiologic abnormality (BBPT-SCIWORA) in children is rare in clinical practice and leads to lower limb motor dysfunction. There are few clinical studies on BBPT-SCIWORA and even fewer on treatments for BBPT-SCIWORA-induced lower limb motor dysfunction.
Objective:
To explore the therapeutic effect of acupuncture at bilateral spine acupoints combined with lower limb acupoints in BBPT-SCIWORA.
Case presentation:
This study reported four cases of BBPT-SCIWORA after dancing, two of which received a unique medium-frequency electroacupuncture treatment. They were all females aged between 5 and 12 years old. They were diagnosed with BBPT-SCIWORA by magnetic resonance imaging (MRI), transferred to the rehabilitation department for lower limb dysfunction, and received rehabilitation treatments and acupuncture. Cases 1 and 2 received acupuncture treatment for lower limb acupoints, while Cases 3 and 4 received acupuncture treatment at the bilateral spine acupoints beside the lesion and lower limb acupoints. Cases 3 and 4 achieved better American spinal injury association (AIS) grades and lower extremity motor scores (LEMS) than Cases 1 and 2 after treatment.
Conclusion:
Acupuncture treatment of beside bilateral spine acupoints plus lower limb acupoints therapy might facilitate early lower limb motor function recovery in children with BBPT-SCIWORA.
