Surfer’s myelopathy: a rare presentation in a non-surfing setting and review of the literature

Abstract

Background: Surfers myelopathy can be a rapidly devastating disease and little is known surrounding the pathophysiology of the condition. Although the classical pattern of illness has been well reported, it has never been observed in a non-surfing setting.Methods: A 51-year-old demolition worker presented with acute non-traumatic myelopathy. Clinical examination revealed sensory loss to the level of L2. T2-MRI and MRI-DWI revealed a hyperintense signal suggestive of an ischaemic event. A diagnosis of surfer's myelopathy was made and he was commenced on steroid therapy.Results: Following steroid therapy and fluid management the patient was discharged after 6 days with minor anaethesia but significant overall neurological improvement. Case Report Conclusions: Diagnosis of SM requires a thorough history, clinical examination and imaging (MRI, MRI-DWI IntroductionFirst defined by Thompson et al. [2004], surfer's myelopathy (SM) is a rare diagnosis of acute non-traumatic spinal cord infarction most commonly found in first time surfing patients (1). Postulated to only be driven by the excessive forces applied during surfing, from both manoeuvring and the surrounding waves, the underlying pathophysiology is driven by hyperextension of the spine leading to vascular damage and consequent ischaemia to distal spinal cord segments. The hyperextension itself is believed to increase tension on both the spinal cord and surrounding vasculature, causing possible avulsion of perforating vessels and secondary vasospasm leading to transient ischaemia. This theory has recently been challenged in a recent review by Freedman et al. [2016] suggesting other mechanisms including inferior vena caval compression while surfers lie prone on the board (prolonged valsalva manoeuvre), or embolization in the central/sulcal arteries secondary to spinal disk damage (2).Regardless of etiology, evidence of cord infarction is demonstrable through magnetic resonance imaging (MRI) following presentation, with a classical T2 hyperintensity visible on a longitudinal view. Deterioration is rapid (within hours), with presentation variable including symptoms of back pain, paraplegia, hyperalgesia and non-specific neurological symptoms (3). Similar to presentation, rates of improvement are equally as variable, ranging from no improvement to complete recovery. Lastly, It is important to recognise that the majority of patients are young and generally have no existing spinal or vascular pathology. Hence delayed (>24 hours) presentation may have significant impact on overall outcomes.Although there have been 64 cases published since 2004, standardisation in the management algorithm of The purpose of the present report is (1) to present a possible case of SM involving a non-surfing mechanism and (2) to establish a succinct management algorithm in patients presenting with possible SM. Case presentationA 51-year-old male demolition worker who presented after commencing work with bilateral lower limb paraesthesia and numbness 2 days prior. He reported acute deterior...

Surfer’s myelopathy without surfing: a report of two pediatric patients

“…As a result of her imaging findings and history, she was diagnosed with SM. Maharaj et al 5 reported a 51-year-old with the same clinical and MRI findings but without a history of spinal hyperextension.…”

Non-traumatic myelopathy associated with prolonged hyperextension during swimming: an unusual variation of Surfer’s Myelopathy

“…Previous case reports and series have reported age-ranges for affected individuals between 7 [6] and 51 [5]. Our patient is therefore the oldest reported case of SM, and the only reported with pre-existing vertebral pathology.…”

“…Cases of non-traumatic spinal cord ischaemia have been described in surgical patients with an intra-operative hyperlordotic posture [4], demolition workers [5], cheerleaders [6], acute spinal hyperextension [7], and clearly (usually novice) surfers [1,8], but never before in swimmers.…”

Paraplesia after surfing in a young female novice surfer: a case report on surfer's myelopathy

“…Among case reports of surfer's myelopathy without surfing, we found three reports of four cases, by searching PubMed with the key words “surfer's myelopathy” and “without surfing.” In addition, Segami et al . reported cases that resemble surfer's myelopathy .…”