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© Springer International Publishing Switzerland 2016 I.M. Eltorai, Rare Diseases and Syndromes of the Spinal Cord, DOI 10.1007/978-3-319-45147-3_148
148

Trampoline Spinal Cord Injuries in Pediatrics

148.1 Definition

Cervical spine injuries from trampoline sport in children are second only to football injuries and result in paraplegia and tetraplegia in approximately 5 % of all trampo­line injuries.

148.2 Incidence

According to Brown and Lee, in 1998 trampolines were responsible for over 6500 pediatric cervical spine injuries. 8–12 % of trampoline injuries resulted in neuro­logical damage.

148.3 Etiology

Spinal hyperextension injuries result from a failed backward fl ip and hyperfl exion injury results from a failed forward fl ip.

148.4 Pathology

Different types of cervical injuries result causing fractures, subluxation, dislocation, and fracture dislocations, disc injuries. These may or may not result in cord injury or facet jumping. These are not prevented by spatters or use of padding because the jumper usually lands in the center of the trampoline mat.
Abstracted from Brown and Lee ( 2000 )
508

148.5 Clinical Picture

Depending on the type of injury, generally there is neck pain, which may radiate, restriction of the neck movement, paresis, or complete paralysis, and in rare cases death ensues.

148.6 Diagnosis

Diagnosis is based on the following criteria:
history neurological examination x-ray fi ndings

148.7 Management

Depends on the type of injury, from closed reduction to open surgery, halo vests different, or types of callus. In permanent neurogenic damage pediatric rehabilita­tion programs.

148.8 Prevention

It is recommended to ban trampolines, since even in the presence of spatters, safety harnesses, injuries cannot be prevented totally.

Reference

Brown PG, Lee M. Trampoline injuries of the cervical spine. Pediatr Neurosurg.
2000;32(4):170–5.
148 Trampoline Spinal Cord Injuries in Pediatrics
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© Springer International Publishing Switzerland 2016 I.M. Eltorai, Rare Diseases and Syndromes of the Spinal Cord, DOI 10.1007/978-3-319-45147-3_149
149

Traumatic Tethering

149.1 Definition

Tethering is to restrict or bind with or as if with a tether or rope, according to the Reader’s Digest Encyclopedia Dictionary. Tethering of the spinal cord is a patho­logical condition of the cord due to its reliant or bundling the caudal position of the neural tube, most commonly due to occult spinal dysraphism, which encompasses one or more entities such as hypertrophied fi lum terminale, lipomeningoecle, a fi brotic fi lum terminale extending from the tip of the conus medullaris to the dura anchoring one to the other causing tethering. Other manifestations of dysraphism are lypomatous mass extending from the center of the spinal cord to the skin through the dystrophic vertebral arch. A common course of tethering is scar tissue formation binding the spinal cord and its roots of a previously operated menigomyelocele or lipomatous hamartoma to the repaired dura or skin.

149.2 Incidence

Developmental anomalies of the distal neural tube are increasingly encountered especially due to modern diagnostic measures. These can be consulted in textbooks of pediatric neurosurgery and orthopedics. The subject of the is presentation is a unique case of tethered cord after traumatic paraplegia resulting in tetraplegia. According to the authors Ragnarsson et al., the only case reported.
Abstracted from Ragnarsson et al. ( 1986 )
510

149.3 Etiology

Progressive neurological deterioration after traumatic paraplegia is usually due to a syrinx or arachnoiditis or a second trauma. In absence of these tethered cord should be thought of. Flexion and extension of the neck poses more stretching and adherent cord.

149.4 Pathology

The mechanical effect of traction on the cord as shown by Barry et al. ( 1957 ), dis- sipates within fi ve segments rostral to the point of tethering. In dysraphism the mechanism is due to traction as well as pressure. As a result of traction there is ischemia which leads to cord atrophy. Yamamda et al. ( 1981 ), demonstrated experi- mentally impairment of the mitochondrial oxidative process under traction. After release of the tethering the spinal cord blood fl ow improves as tested by laser Doppler (Schneider et al. 1993 ). The ischemic changes lead to atrophy as in the case reported.

149.5 Clinical Picture

The case reported by TS Ragnarsson et al. ( 1986 ), showed the following:
A 49 year old man with complete T5 paraplegia of 30 years duration over the last
10 years developed cervical myelopathy. A syrinx and arachnoiditis were ruled out. At operation the cord was found tethered and atrophic. Release of the tethering lead to improvement neurologically.

149.6 Diagnosis

Diagnosis is based on:
1. clinical history
2. radiological diagnosis including CT scan, meylography (MRI was not available at the time)
3. Electrophysiological studies

149.7 Management

Tethering due to dysraphism has different modalities of surgery. In this posttrau­matic case the neurosurgeon after laminectomy found the cord by scarring at the old fracture at its distal side was attenuated cystic bag tethered circumferentially by
149 Traumatic Tethering
511
arachnoid sclerosis. Because the patient had a complete T5 injury they transected 1 cm section of the cord from its distal end and the cord receded almost 10 cm. The procedure was monitored by SSEP, which improved postoperatively. The resected segment was diagnosed neural tissue with atrophy.

References

Barry A, Patten BM, Stewart BH. Possible factors in the development of the Arnold-Chiari malfor-
mation. J Neurosurg. 1957;14(3):285–301.
Ragnarsson TS, Durward QJ, Nordgren RE. Spinal cord tethering after traumatic paraplegia with
late neurological deterioration. J Neurosurg. 1986;64(3):397–401.
Schneider SJ, Rosenthal AD, Greenberg BM, Danto J. A preliminary report on the use of laser-
Doppler fl owmetry during tethered spinal cord release. Neurosurgery. 1993;32(2):214–7.
Yamada S, Zinke DE, Sanders D. Pathophysiology of “tethered cord syndrome”. J Neurosurg.
1981;54(4):494–503.
References

Conclusion

This text was collected for over four decades from different publications of spinal cord. It was collected in the early days from the Index Medicus and later from Pubmed and other online sources. Each subject in this book is given credit to each author, whose cases are presented exactly from their published reports. This book is intended for many practitioners especially, neurologist, neurosurgeon, rehabili­tation, physiatrist, residents, and students of medicine. Each subject is divided into definition, incidence, etiology, pathology, clinical picture, diagnosis, and manage­ment. They have been thoroughly researched and updated; further, case details can be obtained from the references. The subjects were collected mostly from English literature, as well as translated from other languages. This book is an adequate reference for the occasionally encountered case of rare spinal cord clinical patho­logies and rare curiosities. In order to assure progress in future research in this field, it is important to remember the fundamental medical advances that came from studying rare diseases. It is a hope that this book could serve as a model for future rare spinal cord disease research.
© Springer International Publishing Switzerland 2016 I.M. Eltorai, Rare Diseases and Syndromes of the Spinal Cord, DOI 10.1007/978-3-319-45147-3
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