Pediatric acute hyperextension spinal cord injury (PAHSCI), also named as pediatric back bend paralysis, mainly occurs in back-bend training. PAHSCI is complete in most conditions and has an increasing incidence each year. Most patients with PAHSCI have lifelong disability, bringing a heavy economic burden to themselves, their families and society. However, due to lack of clinical guideline for the diagnosis and treatment of PAHSCI at home and abroad, many specialists reveal insufficient knowledge to the prevention, clinical characteristics, treatment and prognosis of this type of injury. PAHSCI may be overlooked as the early neurological symptoms are atypical, and is most likely to be misdiagnosed during the visit. At present, there is no effective treatment, together with poor prognosis and numerous complications. Accordingly, the expert team organized by Chinese Orthopedic Association and Chinese Association of Orthopedic Surgeons, etc, developed the "Guideline for the diagnosis and treatment of pediatric acute hyperextension spinal cord injury (2022 version)" in accordance with the principle of scientificity and practicability to give evidence-based recommendations on PAHSCI from aspects of the diagnosis, etiology, neurological assessment, treatment, prognosis evaluation, complication and prevention, hoping to standardize the diagnosis, treatment and prevention.