title: Pediatric thoracic SCIWORA after back bend during dance practice: a retrospective case series and analysis of trauma mechanisms.
abstract: OBJECTIVE
  The purpose of the study was to describe a unique type of low-energy traumatic pediatric thoracic spinal cord injury without radiographic abnormality (SCIWORA) after a back bend during dance practice and analyze the trauma mechanisms and treatment protocols.
  
  
  METHODS
  This was a retrospective case series from September 2007 to August 2016. The study was conducted at a tertiary medical center in Beijing, China (Xuanwu Hospital, China International Neuroscience Institute [China-INI], Capital Medical University). A total of 12 pediatric patients who had a clear traumatic history after back bend movements and had been diagnosed with thoracic SCIWORA were included. Clinical and imaging data were obtained for each patient. The follow-up data was analyzed. The traumatic mechanisms were investigated by analyzing the patients' medical history, spinal diffusion tensor imaging (DTI) and fiber tractography data.
  
  
  RESULTS
  Of the 12 patients, 11 (91.7%) were younger than 8 years old. The mean age of the patients was 6.6 years. All patients had a clear traumatic history of severe thoracic spinal cord injury after performing back bend movements. The mean follow-up time was 36.5 months. During the follow-up period, 1 patient (8.3%) recovered completely, and 11 patients (91.7%) had unfavorable prognoses, including 4 (33.3%) with incomplete recovery and 7 (58.3%) with no change. Two patients underwent spinal DTI, which showed rupture of the nerve fiber bundle in the section of the injury.
  
  
  CONCLUSIONS
  Back bend movements performed during dance practice may cause pediatric thoracic SCIWORA, particularly in children younger than 8 years old. We suggest that the mechanism of primary injury is the longitudinal distraction of the thoracic spine during back bend movements, which leads to violent distraction of the spinal cord and blunt injury of nerve axons, nerve cells, and small vessels. Spinal DTI may facilitate the diagnosis and prognostic evaluation of SCIWORA.
authors.affiliation: Department of Neurosurgery, Xuanwu Hospital, Capital Medical University, China International Neuroscience Institute (China-INI), Beijing, 100053, China.
authors.forename: Jian
authors.initials: J
authors.lastname: Ren
authors.affiliation: Department of Neurosurgery, Xuanwu Hospital, Capital Medical University, China International Neuroscience Institute (China-INI), Beijing, 100053, China.
authors.forename: Gao
authors.initials: G
authors.lastname: Zeng
authors.affiliation: Department of Neurosurgery, Xuanwu Hospital, Capital Medical University, China International Neuroscience Institute (China-INI), Beijing, 100053, China.
authors.forename: Yong-Jie
authors.initials: YJ
authors.lastname: Ma
authors.affiliation: Department of Radiology, Xuanwu Hospital, Capital Medical University, Beijing, 100053, China.
authors.forename: Nan
authors.initials: N
authors.lastname: Chen
authors.affiliation: Department of Neurosurgery, Xuanwu Hospital, Capital Medical University, China International Neuroscience Institute (China-INI), Beijing, 100053, China.
authors.forename: Zan
authors.initials: Z
authors.lastname: Chen
authors.affiliation: Department of Neurosurgery, Xuanwu Hospital, Capital Medical University, China International Neuroscience Institute (China-INI), Beijing, 100053, China.
authors.forename: Feng
authors.initials: F
authors.lastname: Ling
authors.affiliation: Department of Neurosurgery, Xuanwu Hospital, Capital Medical University, China International Neuroscience Institute (China-INI), Beijing, 100053, China. xwzhanghq@163.com.
authors.forename: Hong-Qi
authors.initials: HQ
authors.lastname: Zhang
mesh_terms: D002648:Child; D002675:Child, Preschool; D003615:Dancing; D056324:Diffusion Tensor Imaging; D005260:Female; D006801:Humans; D015601:Injury Severity Score; D018810:Magnetic Resonance Angiography; D008297:Male; D011379:Prognosis; D012189:Retrospective Studies; D013116:Spinal Cord / Q000000981:diagnostic imaging; D013119:Spinal Cord Injuries / Q000150:complications* / Q000000981:diagnostic imaging / Q000209:etiology*
keywords: Pediatric; SCIWORA; Spinal DTI; Spinal cord injury; Thoracic