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Acute hyperextension myelopathy in children: Radiographic predictors of clinical improvement

Spinal Cord (2022)Cite this article

Subjects

Abstract

Study design

Retrospective case series

Setting

Three hospitals in China.

Objective

Previous research indicates that only neurological status on admission determines prognosis of acute hyperextension myelopathy (AHM). The object of this study is to analyze other unfavorable predictors of AHM in children.

Methods

The clinical data of children with AHM were retrospectively analyzed. The ASIA impairment scale (AIS) grade was recorded upon admission and at last follow-up. Intramedullary lesion length (IMLL) was measured in the sagittal T2-weighted imaging (T2WI) within two weeks after onset; gadolinium enhancement in the cord was recorded for each patient. Relationships among AIS grade, IMLL, gadolinium enhancement in the cord, and clinical improvement were assessed.

Results

A total of 33 patients were included in this retrospective study. IMLL between complete and incomplete injury was significantly different (p < 0.01) in the subacute stage, and no difference was observed in the acute stage. Correlation analysis revealed that AIS grade on admission (r = 0.906, p < 0.001) was significantly positively correlated with clinical improvement. IMLL (r = −0.608, p < 0.001) and abnormal gadolinium enhancement (r = −0.816, p < 0.001) in the cord in the subacute stage were significantly negatively correlated with clinical improvement. There were no associations between IMLL in the acute stage and clinical improvement (r = −0.248, p = 0.242). The statistically significant predictors of clinical improvement were AIS grade on admission, IMLL in the subacute stage, and abnormal gadolinium enhancement.

Conclusion

IMLL in the subacute stage and abnormal gadolinium enhancement in the cord are two other prognostic predictors of AHM in children.

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Fig. 1: MRI of a 7-year-old girl with incomplete SCI.
Fig. 2: MRI of a 5-year-old girl with complete SCI.

Data availability

The datasets generated during this study are available from the corresponding author on reasonable request.

References

  1. Albuja AC, Qaiser S, Lightner DD, Raslau FD, Zafar MS, Bernard PA, et al. Surfer’s myelopathy without surfing: A report of two pediatric patients. Spinal Cord Ser Cases. 2017;3:17008.

    PubMed  PubMed Central  Google Scholar 

  2. Thompson TP, Pearce J, Chang G, Madamba J. Surfer’s myelopathy. Spine (Philos Pa 1976). 2004;29:E353–6.

    Google Scholar 

  3. Chang CW, Donovan DJ, Liem LK, O’Phelan KH, Green DM, Bassin S, et al. Surfer’s myelopathy: A case series of 19 novice surfers with nontraumatic myelopathy. Neurology 2012;79:2171–6.

    PubMed  Google Scholar 

  4. Freedman BA, Malone DG, Rasmussen PA, Cage JM, Benzel EC. Surfer’s myelopathy: A rare form of spinal cord infarction in novice surfers: a systematic review. Neurosurgery 2016;78:602–11.

    PubMed  Google Scholar 

  5. Gandhi J, Lee MY, Joshi G, Khan SA. Surfer’s myelopathy: A review of etiology, pathogenesis, evaluation, and management. J Spinal Cord Med. 2021;44:2–7.

    PubMed  Google Scholar 

  6. Avilés-Hernández I, Garcia-Zozaya I, DeVillasante JM. Nontraumatic myelopathy associated with surfing. J Spinal Cord Med. 2007;30:288–93.

    PubMed  PubMed Central  Google Scholar 

  7. Wang Y, Zhu F, Zeng L, Wang S, Liu Y, Yang L, et al. Surfer myelopathy in children: A case series study. World Neurosurg. 2021;148:e227–41.

    PubMed  Google Scholar 

  8. Cipriano K, Mansfield JT, Batal H, Gosai E. Nontraumatic acute hyperextension myelopathy associated with weightlifting. Am J Phys Med Rehabil. 2021;100:e113–5.

    PubMed  Google Scholar 

  9. Wadia S, Padmanabhan P, Moeller K, Rominger A. Pediatric surfer’s myelopathy. J Emerg Med. 2015;49:e143–5.

    PubMed  Google Scholar 

  10. Maharaj MM, Phan K, Hariswamy S, Rao PJ. Surfer’s myelopathy: A rare presentation in a non-surfing setting and review of the literature. J Spine Surg. 2016;2:222–6.

    PubMed  PubMed Central  Google Scholar 

  11. Teixeira S, Moser F, Kotton RH. Imaging features and differentials in surfer’s myelopathy: A case report. Emerg Radiol. 2016;23:89–92.

    PubMed  Google Scholar 

  12. Dillen WL, Hendricks BK, Mannas JP, Wheeler GR. Surfer’s myelopathy: A rare presentation in a teenage gymnast and review of the literature. J Clin Neurosci. 2018;50:157–60.

    PubMed  Google Scholar 

  13. Nakamoto BK, Siu AM, Hashiba KA, Sinclair BT, Baker BJ, Gerber MS, et al. Surfer’s myelopathy: A radiologic study of 23 cases. AJNR Am J Neuroradiol. 2013;34:2393–8.

    CAS  PubMed  PubMed Central  Google Scholar 

  14. Ren J, Zeng G, Ma YJ, Chen N, Chen Z, Ling F, et al. Pediatric thoracic SCIWORA after back bend during dance practice: A retrospective case series and analysis of trauma mechanisms. Child’s Nerv Syst. 2017;33:1191–8.

    Google Scholar 

  15. Tong AN, Zhang JW, Zhou HJ, Tang HH, Bai JZ, Wang FY, et al. Ischemic damage may play an important role in spinal cord injury during dancing. Spinal Cord. 2020;58:1310–6.

    PubMed  PubMed Central  Google Scholar 

  16. Zou Z, Teng A, Huang L, Luo X, Wu X, Zhang H, et al. Pediatric spinal cord injury without radiographic abnormality: The Beijing experience. Spine (Philos Pa 1976). 2021;46:E1083–8.

    Google Scholar 

  17. Griessenauer CJ, Raborn J, Foreman P, Shoja MM, Loukas M, Tubbs RS. Venous drainage of the spine and spinal cord: A comprehensive review of its history, embryology, anatomy, physiology, and pathology. Clin Anat. 2015;28:75–87.

    PubMed  Google Scholar 

  18. Bickley RJ, Belyea CM, Harpstrite JK, Min KS. Surfing injuries: A review for the orthopaedic surgeon. JBJS Rev. 2021;9:e20.00152.

    Google Scholar 

  19. Xiaodong G, Yaping F, Tiansheng S, Shiqing F, Jiaguang T, Lin C, et al. Clinical guidelines for neurorestorative therapies in spinal cord injury (2021 China version). J Neurorestoratology. 2021;9:31–49.

    Google Scholar 

  20. Pang D. Spinal cord injury without radiographic abnormality in children, 2 Decades Later. Neurosurgery 2004;55:1325–43.

    PubMed  Google Scholar 

  21. Aarabi B, Sansur CA, Ibrahimi DM, Simard JM, Hersh DS, Le E, et al. Intramedullary lesion length on postoperative magnetic resonance imaging is a strong predictor of ASIA impairment scale grade conversion following decompressive surgery in cervical spinal cord injury. Neurosurgery 2017;80:610–20.

    PubMed  Google Scholar 

  22. Aarabi B, Akhtar-Danesh N, Chryssikos T, Shanmuganathan K, Schwartzbauer GT, Simard JM, et al. Efficacy of Ultra-Early (<12 h), Early (12–24 h), and Late (>24–138.5 h) surgery with magnetic resonance imaging-confirmed decompression in american spinal injury association impairment scale grades A, B, and C cervical spinal cord injury. J Neurotrauma. 2020;37:448–57.

    PubMed  PubMed Central  Google Scholar 

  23. Flanagan EP, Krecke KN, Marsh RW, Giannini C, Keegan BM, Weinshenker BG. Specific pattern of gadolinium enhancement in spondylotic myelopathy. Ann Neurol. 2014;76:54–65.

    CAS  PubMed  Google Scholar 

  24. Xie T, Pan L, Yang M, Xu Z, Wu T, Huang H, et al. Analysis of spinal angiograms that missed diagnosis of spinal vascular diseases with venous hypertensive myelopathy: the non-technical factors. Eur Spine J. 2020;29:2441–8.

    PubMed  Google Scholar 

  25. CMulcahey MJ, Gaughan J, Betz RR, Johansen KJ. The International standards for neurological classification of spinal cord injury: Reliability of data when applied to children and youths. Spinal Cord. 2007;45:452–9.

    Google Scholar 

  26. Nakano H, Yamamoto D, Yamagami H, Sekine I, Ofuchi H. Paraplesia after surfing in a young female novice surfer: A case report on surfer’s myelopathy. Acute Med Surg. 2019;6:312–5.

    PubMed  PubMed Central  Google Scholar 

  27. Wilson JR, Jaja BNR, Kwon BK, Guest JD, Harrop JS, Aarabi B, et al. Natural history, predictors of outcome, and effects of treatment in thoracic spinal cord injury: A multi-center cohort study from the North American clinical trials network. J Neurotrauma. 2018;35:2554–60.

    PubMed  Google Scholar 

  28. Zhu F, Liu Y, Zeng L, Wang Y, Kong X, Yao S, et al. Evaluating the severity and prognosis of acute traumatic cervical spinal cord injury: A novel classification using diffusion tensor imaging and diffusion tensor tractography. Spine (Philos Pa 1976). 2021;46:687–94.

    Google Scholar 

  29. David G, Mohammadi S, Martin AR, Cohen-Adad J, Weiskopf N, Thompson A, et al. Traumatic and nontraumatic spinal cord injury: Pathological insights from neuroimaging. Nat Rev Neurol. 2019;15:718–31.

    PubMed  Google Scholar 

  30. Zhu F, Zeng L, Gui S, Liu Y, Wang Y, Cao X, et al. The role of diffusion tensor imaging and diffusion tensor tractography in the assessment of acute traumatic thoracolumbar spinal cord injury. World Neurosurg. 2021;150:e23–30.

    PubMed  Google Scholar 

  31. Klontzas ME, Hatzidakis A, Karantanas AH. Imaging findings in a case of stand up paddle surfer’s myelopathy. BJR Case Rep. 2015;1:20150004.

    CAS  PubMed  PubMed Central  Google Scholar 

  32. Choi J, Seok HY, Kim Y, Kim BJ. Surfer’s myelopathy mimicking infectious myelitis. J Clin Neurol. 2017;13:207–8.

    PubMed  PubMed Central  Google Scholar 

  33. Takakura T, Yokoyama O, Sakuma F, Itoh R, Romero RR. Complete paraplegia resulting from surfer’s myelopathy. Am J Phys Med Rehabil. 2013;92:833–7.

    PubMed  Google Scholar 

  34. Wang W, Ao Q. Research and application progress on dural substitutes. J Neurorestoratology. 2019;7:161–70.

    Google Scholar 

  35. Muralidharan R, Saladino A, Lanzino G, Atkinson JL, Rabinstein AA. The clinical and radiological presentation of spinal dural arteriovenous fistula. Spine (Philos Pa 1976). 2011;36:E1641–7.

    Google Scholar 

  36. Huang H, Chen L, Mao G, Bach J, Xue Q, Han F, et al. The 2019 yearbook of Neurorestoratology. J Neurorestoratology. 2020;8:1–11.

    Google Scholar 

  37. Tran AP, Warren PM, Silver J. The biology of regeneration failure and success after spinal cord injury. Physiol Rev. 2018;98:881–917.

    CAS  PubMed  PubMed Central  Google Scholar 

  38. Jin LY, Li J, Wang KF, Xia WW, Zhu ZQ, Wang CR, et al. Blood-spinal cord barrier in spinal cord injury: A Review. J Neurotrauma. 2021;38:1203–24.

    PubMed  Google Scholar 

  39. Kataoka H, Miyamoto S, Nagata I, Ueba T, Hashimoto N. Venous congestion is a major cause of neurological deterioration in spinal arteriovenous malformations. Neurosurgery 2001;48:1224–30.

    CAS  PubMed  Google Scholar 

  40. Cohen DM, Patel CB, Ahobila-Vajjula P, Sundberg LM, Chacko T, Liu SJ, et al. Blood-spinal cord barrier permeability in experimental spinal cord injury: Dynamic contrast-enhanced MRI. NMR Biomed. 2009;22:332–41.

    PubMed  PubMed Central  Google Scholar 

  41. Cho YE, Shin JJ, Kim KS, Chin DK, Kuh SU, Lee JH, et al. The relevance of intramedullary high signal intensity and gadolinium (Gd-DTPA) enhancement to the clinical outcome in cervical compressive myelopathy. Eur Spine J. 2011;20:2267–74.

    PubMed  PubMed Central  Google Scholar 

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Acknowledgements

We want to thank all the patients for their participation in this research.

Funding

This study was supported by National Natural Science Foundation of China (81873999, 81672158).

Author information

Affiliations

  1. Department of Orthopedics, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, 430022, China

    Yulong Wang, Lian Zeng, Guixiong Huang, Yizhou Wan, Kaifang Chen & Xiaodong Guo

  2. Department of Orthopaedic Surgery, Affiliated Xinqiao Hospital, Third Military Medical University (Army Medical University), Chongqing, 400037, China

    Fengzhao Zhu

  3. Department of Rehabilitation, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, 430030, Hubei, China

    Sheng Yao

Authors
  1. Yulong Wang
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  2. Lian Zeng
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  8. Xiaodong Guo
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Contributions

YW: Conceptualization, Methodology, Software, Writing-Original Draft, Formal analysis, Data curation, Writing-Reviewing, and Editing. LZ: Conceptualization, Methodology, Software, Validation, Writing-Original Draft. FZ: Conceptualization, Methodology, Validation, Writing-Reviewing, and Editing. GH: Investigation, Data Curation. YW: Investigation, Software. SY: Data curation. KC: Investigation, Validation. XG: Resources, Writing-Review & Editing, Supervision, Funding acquisition. All authors revised it critically and approved the version to be published.

Corresponding author

Correspondence to Xiaodong Guo.

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The authors declare no competing interests.

Ethics approval

This retrospective study was approved by the Ethics Committee of Tongji Medical College, Huazhong University of Science and Technology.

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Wang, Y., Zeng, L., Zhu, F. et al. Acute hyperextension myelopathy in children: Radiographic predictors of clinical improvement. Spinal Cord (2022). https://doi.org/10.1038/s41393-021-00739-w

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