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Acute hyperextension myelopathy in children: Radiographic predictors of clinical improvement


Study design

Retrospective case series


Three hospitals in China.


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.


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.


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.


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.


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


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

Author information




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).

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