Surfer’s myelopathy: an atypical case presentation

Gilbert, Courtney; Kirshblum, Steven; Miller, Amanda; Nieves, Jeremiah

doi:10.1038/s41394-020-0297-2

Cited by 2 publications

(2 citation statements)

References 23 publications

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“…In a study by Chang et al [8] (2012), they found that treatment with methylprednisolone did not have significant outcomes, and the mean arterial pressure did not correlate with outcomes. The most effective intervention was intensive multidisciplinary rehabilitation [3,9,10] . Neurological recovery has been shown to vary from complete recovery to minimal recovery [2] …”

Section: Discussionmentioning

confidence: 99%

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Acute flaccid paralysis of a new surfer

Loh¹,

Atresh²,

Ferguson³

2022

Medicine

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Rationale: Surfer's myelopathy is a rare atraumatic spinal cord injury most frequently experienced by novice surfers. Patients often experience back pain, followed by motor, sensory, bowel, and bladder involvement. Here, we report a case of surfer's myelopathy.Patient concerns: The patient presented with acute low back pain associated with lower limb weakness, sensory loss, urinary retention, and perineal paraesthesia 1 hour after her first surf lesson.Diagnosis: On arrival at the emergency department, she was noted to have flaccid paralysis with flickers in both lower limbs, reduced sensation in the midthoracic region, reduced anal tone, and saddle anesthesia. Magnetic resonance imaging of the spine revealed evidence of restricted diffusion from T6 to the level of the conus. Extensive investigations, including cerebrospinal fluid analysis, vasculitides/paraneoplastic screening, and further imaging, were unremarkable. She was diagnosed with complete T7 spinal cord injury secondary to surfer's myelopathy.Interventions: She subsequently received methylprednisolone and was transferred to the spinal injury unit for rehabilitation. As she experienced persistent neuropathic pain at the level of the injury, she received input from the local pain team. One month after the injury, the patient developed swelling of the right thigh associated with reduced internal and external rotation of the right hip, impacting rehabilitation. The patient was diagnosed with heterotopic ossification following a triple-phase bone scan. She then received intravenous zolendronic acid, which had a good effect.Outcomes: Four months after the initial presentation, she was discharged to the community. Despite no improvement in her neurological status, she was independent of transfers and mobility with a wheelchair. In addition, she managed her neurogenic bowel and bladder independently with intermittent self-catheterization and a transanal irrigation system. At 6 months, she engaged well with returning to drive program and vocational rehabilitation.Lessons: Neurological recovery from surfer's myelopathy has been shown to vary from complete recovery to minimal recovery. With a spinal-specific rehabilitation program, this patient remains independent of her activities of daily living. Surfer's myelopathy often occurs in inexperienced surfers; therefore, it is crucial to provide education to surfers and instructors.

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Section: Discussionmentioning

confidence: 99%

“…The most effective intervention was intensive multidisciplinary rehabilitation. [ 3 , 9 , 10 ] Neurological recovery has been shown to vary from complete recovery to minimal recovery. [ 2 ]…”

Section: Discussionmentioning

confidence: 99%