Surfer’s Myelopathy : Case Series and Literature Review

Abstract

Three male patients diagnosed with surfer’s myelopathy (19–30 years) were admitted to our hospital. All three patients were novice surfers showing a typical clinical course of rapid progression of paraplegia following the onset of back pain. Typical history and magnetic resonance imaging features indicated the diagnosis of surfer’s myelopathy. Two patients received high-dose steroid therapy and the other was treated with induced hypertension. One patient treated with induced hypertension showed almost full recovery; however, two patients who received high-dose steroid therapy remained completely paraplegic and required catheterization for bladder and bowel dysfunction despite months of rehabilitation. Our case series demonstrates the potentially devastating neurological outcome of surfer’s myelopathy; however, early recovery in the initial 24–72 hours of presentation can occur in some patients, which is in accordance with previous reports. Ischemic insult to the spinal cord is thought to play a crucial role in the pathophysiology of surfer’s myelopathy. Treatment recommendations include hydration, induced hypertension, early spinal angiography with intra-arterial intervention, intravenous tissue plasminogen activator, and high-dose steroid therapy; however, there is no standardized treatment option available. Early recovery appears to be important for long-term neurological outcome. Induced hypertension for initial treatment can be helpful for improving spinal cord perfusion; therefore, it is important for early and long-term neurological recovery. Education and awareness are essential for preventing surfer’s myelopathy and avoiding further deterioration of neurological function.

Spontaneous conus medullary infarction in the absence of cardiovascular risk factors

“…Surfer's myelopathy, a rare nontraumatic spinal cord injury, should also be a consideration when clinical history supports that injury is preceded by surfing, especially in novice surfers. Ischemia may contribute to its pathophysiology, and neuro‐imaging findings can be similar to SCI, but case reports show good recovery 2 . Interestingly, a study showed that specific physical maneuvers such as lifting or Valsalva preceded symptom onset in SCI in 25% of cases 3 …”

“…Recognizing the challenge in SCI diagnosis, Zalewski et al 2 proposed potential diagnostic criteria for SCI based on retrospective analysis. Essentially, SCI should be considered in patients with acute nontraumatic myelopathy with onset to nadir of severe deficits occurring within 12 hours or less.…”

“…CSF analysis should not show signs of inflammation. These symptoms presenting together in the absence of a strong alternative diagnosis are the working criteria for SCI diagnosis 2 …”

Hyperextension‐Induced Dorsal Cord Syndrome: Case Presentation

“…Treatment for spinal cord infarction varies and depends on etiology. Strategies successfully used for surfer's myelopathy include hydration, induced hypertension, spinal angiography with intra‐arterial intervention, intravenous tissue plasminogen activator, and high‐dose steroid therapy . These therapies are likely to be beneficial in PSA infarction too.…”

Anterior Spinal Artery Syndrome due to Intervertebral Disc Herniation

“…Pathologies affecting the anterior spinal artery or ASA commonly include arteriovenous malformation, vasculitis, iatrogenic causes[4], [5]. Rarer causes include hyperextension positioning[6], fibrocartilaginous embolism, thoracic disk herniation, and cervical spondylosis[7]. Anterior spinal artery syndrome (ASAS) secondary to disk herniation yields only a few cases reported so far.…”