Trampoline Training Trauma: A Diver's Injury

Abstract

HISTORY: A 15 year old male presented to the emergency department with back pain after sustaining an injury while practicing a diving routine on the trampoline. He was in forward rotation when he landed awkwardly on his chin and upper chest, sending his back into hyperextension with his legs landing above his head. He felt immediate low back pain and complete loss of sensory and motor function of his legs for about 30 seconds. All sensory and motor function subsequently returned and he was able to ambulate from the trampoline into the home. He denied ongoing sensory or motor deficits in his legs, loss of consciousness, neck pain, urinary or bowel incontinence, or upper extremity weakness. PHYSICAL EXAMINATION: Examination revealed a well appearing male who was able to ambulate slowly but independently with normal gait. He had midline tenderness in the upper lumbar vertebrae. There was normal alignment of the spine without step offs. His strength was 5/5 and reflexes were 2+ in lower extremities. He did not have deficits to touch sensation and did not have saddle anesthesia. DIFFERENTIAL DIAGNOSES: 1. Spinal cord contusion 2. Lumbar vertebral fracture 3. Lumbar sprain 4. Acute spondylolysis or spondylolisthesis 5. Lumbosacral neurapraxia TESTS AND RESULTS: Xray of cervical spine, chest, and pelvis: unremarkable CT cervical spine: unremarkable MRI cervical-thoracic-lumbar: - traumatic injury of the lumbar spine with disruption of the interspinous ligament at the L1-L2 level - small ventral extradural hematoma contained by the posterior longitudinal ligament at L2-L4 MRI lumbar spine, hospital day #2: - decrease in size and cradiocaudal extent of the ventral extradural collection - edema within psoas and paraspinal muscles at L2-L4 FINAL DIAGNOSIS: Extradural hematoma of lumbar spine at L2-L4 Tear of interspinous ligament at L1-L2 TREATMENT AND OUTCOMES: 1. Admission to PICU for close neurologic monitoring with neurosurgery and trauma on consult. He did not report further numbness or tingling in lower extremities 2. Physical therapy 3. Stepped down to general pediatric floor on hospital day #2 4. Discharged on hospital day #3 with lumbar sacral orthosis brace 5. Experienced ongoing headaches for several weeks 6. Back to activity as tolerated, continue to monitor recovery.