J Korean Neurosurg Soc.  2018 Nov;61(6):767-773. 10.3340/jkns.2017.0262.

Surfer's Myelopathy : Case Series and Literature Review

• Choi JH
• Ha JK
• Kim CH
• Park JH

• KMID: 2428120
• DOI: http://doi.org/10.3340/jkns.2017.0262

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.

Keyword

Water sports; Spinal cord injuries

MeSH Terms

Angiography
Back Pain
Catheterization
Catheters
Diagnosis
Education
Humans
Hypertension
Magnetic Resonance Imaging
Male
Paraplegia
Perfusion
Rehabilitation
Spinal Cord
Spinal Cord Diseases*
Spinal Cord Injuries
Tissue Plasminogen Activator
Urinary Bladder
Tissue Plasminogen Activator

Figure

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  Fig. 1. Case 1 : a 30-year-old Korean male. Midline sagittal T2-weighted MRI of the whole spine was obtained at the ER. MRI findings revealed hyperintense signals of the anterior central cord on T2-weighted imaging from T7 to the conus. MRI : magnetic resonance imaging, ER : emergency room.

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  Fig. 2. Case 2 : a 19-year-old healthy Korean male. Midline sagittal T2-weighted MRI of the whole spine was obtained at the ER. MRI showed increased T2 signal intensity in the gray matter of the central spinal cord from T10 to the conus. MRI : magnetic resonance imaging, ER : emergency room.

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  Fig. 3. Case 3 : a 21-year-old Korean male. Midline sagittal T2-weighted MRI of the whole spine was obtained at the ER. Increased signal and mild enlargement of the lower thoracic cord below the T10 vertebral level to the conus medullaris were observed. MRI : magnetic resonance imaging, ER : emergency room.

Reference

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