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Objective:To summarize the clinical characteristics and prognosis of acute hyperextension spinal cord injury (SCI) in children, and to provide some recommendations for the treatment and prevention of this disease.Methods:Reviewed the data of children of SCI after sustained or repeated hyperextension of the spine at Wuhan Union Hospital and Wuhan Children's Hospital from September 2010 to September 2020. According to the American Spinal Injury Association impairment scale (AIS grade), the patients were divided into complete SCI group and incomplete SCI group. The age, symptoms and evolution after injury, neurological level of injury, imaging data, laboratory examination data, prognosis and complications of the two groups were analyzed. Retrospectively summarize the characteristics of this type of injury.Results:Forty-four cases of acute hyperextension SCI in children were included. Their age ranged from 3 to 10 years old, 95% of them were under 8 years old and 95% of them were female. There was no significant difference in age at injury and time of dance training between children with complete SCI and incomplete SCI. Back and leg pain, lower limb weakness or paresthesia, and rapidly progress to complete or incomplete SCI in a short period were typical symptoms. All blood test results anddiagnostic analysis of cerebrospinal fluid were unremarkable or negative. There was no fracture or dislocation in the whole spine. Magnetic resonance imaging showed a longitudinally extended intramedullary high-intensity signal in the thoracolumbar spinal cord. Complete SCI accounted for 60% of all cases, and the prognosis was poor with spinal cord atrophy and various complications.Conclusion:Children younger than 10 years old after sustained or repeated hyperextension of the spine may suffer acute hyperextension SCI. Children with complete SCI have poor prognosis and serious complications. Therefore, prevention of this type of injury is the best strategy.
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Objective To evaluate the feasibility of using the posterior approach with cervical pedicle screw fixation technique for the treatment of lower cervical spine fractures and dislocations.Methods Thirty patients suffered lower cervical fractures and dislocations were retrospectively analyzed,and they were underwent cervical pedicle screw system fixation surgery from January 2010 to December 2012.There were 22 males and 8 females,with an average age of 41 years (range,24-61 years).Eight injuries were located at C4,5,12 at C5,6,and 10 at C6.7.According to the American Spinal Cord Injury Association (ASIA)impairment scale,8 cases were grade A,12 were grade B,5 were grade C,3 were grade D,and 2 were grade E.Results Reduction and fixation of the injured segments were performed via a posterior approach in all 30 patients.One hundred and forty pedicle screws were inserted successfully in all patients on the postoperative radiographic and CT scans.All the patients were followed up for 3-23 months,with the average of 11 months.According to the ASIA impairment scale,eight cases with grade A were still grade A,but the feeling and movement improved obviously.Ten grade B improved to grade C and the rest cases were complete recovery after operations.During the course of the follow up,solid bone union was achieved in all patients,and there were no hardware failures.All the patients' postoperative MRI showed disappearance of the spinal cord compression after reduction in all cases.Conclusion For the patients of lower cervical fractures and dislocation,the first choice of operation should be the posterior approach reduction and fixation with cervical pedicle screw.The correct lengthwise traction method could unblock the locked facet effectively,and prevent the retrusion of disc and the further injury of spinal cord.For the patients of disc disruption,the posterior approach could be used only.The cervical pedicle screw system could provide three-dimensional reduction of the injured cervical segments and the adequate mechanical strength.The posterior approach combined with pedicle screw fixation is feasible and effective for the treatment of lower cervical fractures and dislocation.