LETTER TO THE EDITOR
Year : 2012  |  Volume : 7  |  Issue : 1  |  Page : 70-71

A reminder of the dangers of trampolining: Spinal cord infarction secondary to hyperextension injury during trampolining

Rohini Rattihalli, Arif Khan, Nahin Hussain
Department of Paediatric Neurology, Leicester Royal Infirmary, University Hospitals of Leicester NHS Trust, Leicester, United Kingdom

Date of Web Publication

28-Jun-2012

Correspondence Address:
Nahin Hussain
Department of Paediatric Neurology, Leicester Royal Infirmary, Infirmary Square, Leicester, LE1 5WW
United Kingdom

Source of Support: None, Conflict of Interest: None

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DOI: 10.4103/1817-1745.97632

How to cite this article: Rattihalli R, Khan A, Hussain N. A reminder of the dangers of trampolining: Spinal cord infarction secondary to hyperextension injury during trampolining. J Pediatr Neurosci 2012;7:70-1

How to cite this URL: Rattihalli R, Khan A, Hussain N. A reminder of the dangers of trampolining: Spinal cord infarction secondary to hyperextension injury during trampolining. J Pediatr Neurosci [serial online] 2012 [cited 2023 Sep 28];7:70-1. Available from: https://www.pediatricneurosciences.com/text.asp?2012/7/1/70/97632

Dear Sir,

A 15-year-old boy presented to the A and E department with weakness and pins and needles in both arms. He gave a history of fall from a household trampoline in hyperextension 3 days before presentation. He reported neck pain on the previous day. This was followed by pins and needles and numbness over the shoulders, which progressed down to the arm and forearms. On examination, there was patchy sensory loss in both upper limbs, with decreased power of 4/5 MRC. Lower limb examination was normal. Decreased power in the upper limbs was worse distally than proximally. There was no spinal tenderness. In the next 24 hours, he developed difficulty in voiding urine, difficulty in walking, worsening gait, and additional sensory involvement of lower limbs. Forty-eight hours after presentation, he was quadriplegic, with power of 3/5 MRC in the limbs, elicitable reflexes, no sensory level. Superficial pain, temperature discrimination was lost bilaterally with relative preservation of light touch, vibration, and position sense, and his bladder was catheterized. Magnetic resonance imaging of the spine showed linear high signal within the spinal cord extending from C4/C5 to C7levels [Figure 1], and was diagnosed as acute spinal cord infarction. After weeks of inpatient neuro-rehabilitation, he is making slow but steady progress.

Figure 1: Linear high signal within the spinal cord extending from C4/C5 to C7 levels in keeping with acute spinal cord infarction Click here to view

Spinal cord infarction in children has been recognized for several decades, but remains rare and difficult to diagnose. ^[1] No reports of spinal cord infarct caused due to trampolining were found in the literature. There are several differentials for acute flaccid weakness with sensory symptoms, including acute transverse myelopathy, viral myelitis, Guillain-Barré syndrome, and mass lesions in the spinal canal, which can develop acutely but have discernibly slower evolution than the vascular lesion like spinal cord infarction. Pointing toward the diagnosis were acute presentation, pattern of weakness, sensory symptoms, lacking a sensory level on the body, loss of pain and temperature discrimination with preservation of vibration and joint position sense, and involvement of sphincters.

There has been an unprecedented surge in the popularity and sales of trampolines in the UK and in the number of children attending emergency departments with associated injuries. The Royal Society for the Prevention of Accidents provides guidelines ^[2] for the safe use of trampolines; however it is clear that these are largely not followed. In a study conducted in a UK hospital emergency department ^[3] between May and September 2008, it was noted that 131 children presented with trampolining injuries. Out of these 59% had no net present and 66% had no supervising adult. A Scottish study ^[4] which analyzed 50 cases presenting to the accident and emergency department at their hospital over 6 weeks showed that multiple users were present in 80% of the cases, there was lack of safety net in 64% of the cases and there was lack of adult supervision in 46% of the cases. Adult supervision and appropriate safety measures can reduce the risk of injury but the only way to completely obviate them is by avoidance. ^[5]

 

References

1.	Nance JR, Golomb MR. Ischemic spinal cord infarction in children without vertebral fracture. Pediatr Neurol 2007;36:209-16.   [PUBMED]  [FULLTEXT]
2.	Available from: http://www.rospa.com/leisuresafety/adviceandinformation/leisuresafety/trampolinesafety.aspx. [2011 Aug 12].
3.	Wootton M, Harris D. Trampolining injuries presenting to a children's emergency department. Emerg Med J 2009;26:728-31.   [PUBMED]  [FULLTEXT]
4.	Bogacz A, Paterson B, Babber A, Menelaws S, Drew T. Trampoline injuries. How to avoid injury. BMJ 2009;338: b2197.   [PUBMED]  [FULLTEXT]
5.	Leonard H, Joffe AR. Children presenting to a Canadian hospital with trampoline-related cervical spine injuries. Paediatr Child Health 2009;14:84-8.   [PUBMED]  [FULLTEXT]

Figures

  [Figure 1]

This article has been cited by 1 Surfer's Myelopathy Brett A. Freedman, David G. Malone, Peter A. Rasmussen, Jason M. Cage, Edward C. Benzel Neurosurgery. 2016; 78(5): 602 [Pubmed] | [DOI]