Surfer's Myelopathy - A Case Report -

Dong-Ho Kwak; Young-Hoon Kim; Kee-Yong Ha; Sang-Il Kim; Hyung-Youl Park; Joo-Hyun Ahn

doi:10.4184/jkss.2017.24.4.241

Journal List > J Korean Soc Spine Surg > v.24(4) > 1076149

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Kwak, Kim, Ha, Kim, Park, and Ahn: Surfer's Myelopathy - A Case Report -

Case Report

Journal of Korean Spine Surg 2017;24(4):241-245.

Published online: 31 December 2017

DOI: https://doi.org/10.4184/jkss.2017.24.4.241

Surfer's Myelopathy - A Case Report -

Dong-Ho Kwak, M.D., Young-Hoon Kim, M.D., Ph.D., Kee-Yong Ha, M.D., Ph.D., Sang-Il Kim, M.D., Hyung-Youl Park, M.D., Joo-Hyun Ahn, M.D.

Department of Orthopedic Surgery, Seoul St. Mary's Hospital, College of Medicine, The Catholic University of Korea, Seoul, Korea

Corresponding author: Young-Hoon Kim, M.D., Ph.D. ORCID ID: https://orcid.org/0000-0003-1237-4600 Department of Orthopedic Surgery, Seoul St. Mary's Hospital, College of Medicine, The Catholic University of Korea, 222, Banpo-daero, Seocho-Ku, Seoul, 06591, Republic of Korea TEL: +82-2-2258-2837, FAX: +82-2-535-9834 E-mail: boscoa@catholic.ac.kr

Received 17 August 201717 August 2017 Accepted 2 October 2017

This is an Open Access article distributed under the terms of the Creative Commons Attribution Non-Commercial License (http://creativecommons.org/licenses/by-nc/4.0/) which permits unrestricted non-commercial use, distribution, and reproduction in any medium, provided the original work is properly cited.

Abstract

Study Design

A case report.

Objectives

To report a rare cause of non-traumatic spinal cord injury (SCI) during surfing

Summary of Literature Review

Surfer's myelopathy is a non-traumatic SCI associated with the hyperextension posture during paddling in surfing. Although the definite pathomechanism has not been identified, cord ischemia followed by arterial infarction may be related to this injury.

Materials and Methods

A young healthy male patient presented with a SCI that occurred during his first time surfing. Magnetic resonance imaging revealed a T2-hyperintense lesion in the spinal cord from D10 to the conus medullaris.

Results

The patient completely recovered without any neurologic deficits after steroid therapy and other forms of supportive management.

Conclusions

Since surfing is becoming more common in Korea, awareness of surfer's myelopathy is important for early diagnosis and proper management.

Keywords: Spinal cord injuries, Spinal cord ischemia, Surfer's myelopathy

REFERENCES

1. Thompson TP, Pearce J, Chang G, et al. Surfer's myelopathy. Spine (Phila Pa 1976). 2004 Aug 15; 29(16):E353–6. DOI: 10.1097/01.BRS.0000134689.84162.E7.

2. Chang CW, Donovan DJ, Liem LK, et al. Surfers’ myelopathy: a case series of 19 novice surfers with nontraumatic myelopathy. Neurology. 2012 Nov 27; 79(22):2171–6. DOI: 10.1212/WNL.0b013e31827595cd.

3. Freedman BA, Malone DG, Rasmussen PA, et al. Surfer’'s Myelopathy: A Rare Form of Spinal Cord Infarction in Novice Surfers: A Systematic Review. Neurosurgery. 2016 May; 78(5):602–11. DOI: 10.1227/NEU.0000000000001089.

4. Cheshire WP, Santos CC, Massey EW, et al. Spinal cord infarction: etiology and outcome. Neurology. 1996 Aug; 47(2):321–30. DOI: 10.1212/WNL.47.2.321.

5. Baik MY, Jeong SH, Lee WW, et al. Surfer's myelopathy. J Korean Neurol Assoc. 2016; 34(2):145–9. DOI: 10.17340/jkna.2016.2.11.

6. White BC, Stirling AJ, Paterson E, et al. Diagnosis and management of patients at risk of or with metastatic spinal cord compression: summary of NICE guidance. BMJ. 2008 Nov 27; 337:a2538. DOI: 10.1136/bmj.a2538.

7. Nakamoto BK, Siu AM, Hashiba KA, et al. Surfer's Myelopathy: a radiologic study of 23 cases. AJNR Am J Neuroradiol. 2013 Dec; 34(12):2393–8. DOI: 10.3174/ajnr. A3599.

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9. Tanaka H, Minatoya K, Matsuda H, et al. Embolism is emerging as a major cause of spinal cord injury after descending and thoracoabdominal aortic repair with a contemporary approach: magnetic resonance findings of spinal cord injury. Interact Cardiovasc Thorac Surg. 2014 Aug; 19(2):205–10. DOI: 10.1093/icvts/ivu148.

10. Lieske J, Cameron B, Drinkwine B, et al. Surfer's myelopathy-demonstrated by diffusion-weighted magnetic resonance imaging: a case report and literature review. J Comput Assist Tomogr. 2011 Jul-Aug; 35(4):492–4. DOI: 10.1097/RCT.0b013e31821e277b.

Fig. 1.

Initial thoracolumbar spine magnetic resonance imaging (MRI) (A) and whole-spine MRI (B) showing a T2-hyperintense lesion extending from D10 to the conus medullaris (white arrow). On the D10 axial section, a T2-weighted image revealed a ‘pencil-like’ (white arrow) hyperintense central lesion (C), but normal signal intensity was observed on the T1-weighted image (D).

Fig. 2.

A follow-up T2 weighted sagittal image (A) showing decreased signal intensity compared to the initial magnetic resonance imaging and normal signal intensity on a gadolinium-enhancing T1-weighted image (B). Magnetic resonance angiography revealing no occlusion or stenosis of any segmental artery or the Adamkiewicz artery (white arrow) (C).

Table 1.

Neurologic examination

	Initial	1 day	3 days	28 days
Motor	25 / 25	47 / 47	50 / 50	50 / 50
Sensory (light touch)	34 / 34	50 / 50	56 / 56	56 / 56
Sensory (pin prick)	35 / 35	54 / 54	56 / 56	56 / 56
ASIA Impairment scale	A	D	E	E
Urination/defecation difficulty	Impaired	Impaired	Impaired	Intact
Saddle anesthesia	+	+	+	−
Romberg test	Uncheckable	+	+	−
Treatment	X	IV Dexamethasone (16mg/loading, 4mg/6hours)

ASIA: American spinal injury association impairment scale, IV: Intravenous.

Table 2.

Initial and follow-up imaging results

	Initial MRI	Follow-up MRI
MRI time	6 hours after	5 days after
T1 weighted image	no signal change	no signal change
T2 weighted images	high signal intensity	decreased signal intensity than initial MRI
T2 extent	D10 to conus medullaris	D10 to conus medullaris
MR angiography	(−)	Not specific findings
ASIA impairment scale	A	E

MRI: Magnetic resonance imaging, ASIA: American spinal injury association impairment scale.

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