Surfer's myelopathy: case report and review

Abstract

Nontraumatic spinal cord injury from surfing is a new entity first described in 2004 and likely of ischemic etiology. We report the case of a 25-year-old man who presented to the emergency department with a 2-week history of lower extremity weakness after surfing in Indonesia. The patient reported developing low back pain, lower extremity weakness, sensory changes, and urinary retention shortly after his first surfing lesson. The patient was subsequently diagnosed with surfer's myelopathy. The purpose of this report is to review the clinical presentation, etiology, risk factors, and management of this increasingly described entity. RÉ SUMÉLes blessures à la moelle é piniè re non traumatiques causé es par le surf constituent une nouvelle entité , dé crite pour la premiè re fois en 2004 et d'é tiologie isché mique probable. Nous faisons é tat du cas d'un homme de 25 ans qui s'est pré senté au service des urgences avec un historique de faiblesse aux extré mité s depuis 2 semaines, aprè s avoir fait du surf en Indoné sie. Le patient a rapporté avoir dé veloppé une douleur au bas du dos, une faiblesse des extré mité s infé rieures, des modifications sensorielles et de la ré tention urinaire peu de temps aprè s sa premiè re leç on de surf. On a par la suite diagnostiqué au patient une myé lopathie du surfeur. Le but de ce rapport est de faire la revue du tableau clinique, de l'é tiologie, des facteurs de risque et de la gestion de cette entité de plus en plus souvent mentionné e.Keywords: myelopathy, paraparesis, spinal cord injury, surfer, surfing It is estimated that over 18 million individuals surf worldwide.1 As surfing grows in popularity, surfing injuries are undoubtedly becoming more common. The increasing popularity of this sport is likely attributable, at least in part, to the commercialization of surfing apparel and the freedom and exhilaration of the stereotypical surfing lifestyle. Craniospinal injuries associated with surfing have been previously reported. These injuries are usually traumatic secondary to head impact with the sea floor or due to a direct blow by a surfboard. 1 Surfer's myelopathy is a nontraumatic spinal cord injury that affects novice surfers. To date, only 10 cases of this condition have been reported in the medical literature, and surfer's myelopathy is believed to be an underdiagnosed and thus underreported condition.2,3 We describe a case of a beginner surfer with lower thoracic spinal cord injury that developed insidiously after his first surfing lesson and then review the literature on this condition. CASE REPORTA 25-year-old previously healthy man took a 1-hour surfing lesson in Bali, Indonesia. He reported no untoward traumatic events while surfing. Approximately an hour later, he began to experience low back pain radiating down to his lower limbs, paresthesias, and bilateral lower extremity weakness. In the subsequent hours, he developed urinary retention, increasing abdominal pain, and difficulty ambulating. A hotel doctor saw him, and he was catheterized for 2 L of uri...

Surfer's Myelopathy: A Radiologic Study of 23 Cases

“…1,2 The abnormal T2-signal has been shown to resolve spontaneously in some studies and improve when subjects are treated with steroids in other studies. 1,4,7 Descriptions of chronic MR imaging changes in surfer’s myelopathy have not been reported.…”

Surfer’s Myelopathy : Case Series and Literature Review

“…They were commonly taking their first lesson and otherwise young and healthy without prior spinal or vascular problems. Other case reports and series were subsequently published after Thompson’s introduction of this entity [ 1 , 2 , 7 - 9 , 12 , 16 , 18 , 19 , 22 , 26 , 28 ]. Thompson et al [ 29 ] proposed this condition as an ischemic insult to the spinal cord; therefore, they tried triple H therapy (hypertension, hypervolemia, and hemodilution) and high-dose steroids in some cases to improve outcomes.…”

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

“…As shown in Table 1, adapted from a recent review by Freedman et al [2016], the routine use of steroids has been of benefit in a mere 55% of cases (n=22) (2). Early steroid therapy has been efficacious in the setting of acute cord injuries including transverse myelitis (key differentials), hence, as SM patients are generally at minimal risk of adverse effects due to the low duration of therapy, is appropriate to initiate (2,10,19). In our case the patient recovered rapidly following his admission, and aside from fluid management he did not receive any further therapy aside from the steroids.…”

“…Although there have been 64 cases published since 2004, standardisation in the management algorithm of these patients is yet to be achieved (1,2,(4)(5)(6)(7)(8)(9)(10)(11)(12)(13)(14)(15)(16)(17)(18). Several interventions have been proposed, including early steroid therapy and anticoagulation, though the rarity of cases has largely prevented quality research on the matter.…”