1266 - Squatting-Associated Traumatic Spinal Cord Injury in a Pediatric Patient

Case Diagnosis: T10 AIS B Spinal Cord Injury

Case Description: A previously-healthy 15-year-old female was performing an approximately two times bodyweight back squat when she experienced sudden-onset mid-back pain accompanied by immediate loss of lower extremity sensation and strength. Imaging revealed unstable T11 vertebral body fracture complicated by anterolisthesis of T10 and T11 resulting in >50% spinal cord compression, cord edema from T9-T11, and intramedullary hemorrhage. She subsequently underwent emergent T11 laminectomy, superior facetectomies, and posterior spinal instrumentation and fusion from T8-L2. Spinal cord injury was graded as a T10 AIS B by ASIA exam performed 2.5 weeks post-insult. Pre-injury risk factors were reviewed and negative for female athlete triad, irregular menses, and significant thyroid or parathyroid derangement. Following acute inpatient stay significant for spinal shock, patient was admitted to inpatient rehabilitation for therapeutic optimization, equipment training, and management of spasticity, neurogenic bowel, and neurogenic bladder.

Discussions: Compression fractures are rare in the pediatric population, and typically associated with high-velocity mechanisms. This case is unique in that the patient sustained a significant osseous and neurologic injury while engaging in a common strength activity without clear endocrinologic, iatrogenic, malignant, or dietary factors that can predispose to weakened bone density. The patient did endorse pre-injury moderate, intermittent back pain in the setting of high levels of activity which may have been indicative of underlying pre-morbid spondylolysis, however this cannot be confirmed due to lack of pre-morbid imaging. To our knowledge, there have been no cases of squatting-related compression fractures complicated by significant spinal cord injury in pediatric patients reported in the literature.

Conclusions: We report the first known case of a spinal cord injury sustained during heavy weightlifting exercise (squatting) in a pediatric patient. This peculiar presentation should prompt discussion of the safety of heavy weight resistance training in the growing adolescent.