Surfer’s Myelopathy

Key Points:  

  • Surfer’s myelopathy is a rare, acute, atraumatic myelopathy that occurs in novice surfers.
  • Afflicted individuals are often thin, have poorly developed back musculature, but are otherwise healthy.
  • Symptoms typically start with mild or intense back pain, rapidly progressing to complete or incomplete myelopathy.
  • Clinical and imaging findings have suggested a vascular etiology leading to acute spinal infarction.
  • T2 MRI characteristically exhibits increased signal intensity within the central portion of the spinal cord and associated cord swelling with 24-72 hours after onset.
  • Prognosis is almost exclusively predicted by the severity of deficit at presentation and those experiencing full recovery usually do so within the first 24 hours.

Context:

This recent systematic review by Freedman et al (1) provides an in-depth overview of this rare form of myelopathy, first reported in 2004.

The review included 13 articles, comprising 64 individual cases, 51 of which were male.  Some additional characteristics identified were:

  • 31% of the patients experienced a disassociated sensory deficit, with the remainder having a total sensory loss.
  • 51% of the patients had complete motor loss.
  • In most cases, the nadir of deficit was achieved within one hour of onset.
  • Variable degrees of recovery were seen, but only in those who had some degree of preserved sensation at the peak deficit.
  • Steroids were administered in 30 patients and found to be beneficial in those patients having some degree of sensory preservation at presentation.

Several additional aspects of this paper may hold interest for the Chiropractic Neurologist.

It references the largest systematic review of acute spinal cord infarction performed to date, in which aortic disease, aortic surgery, or systemic hypo perfusion accounted for 66% of the cases.

Additional potential mechanisms of spinal vascular insult are discussed which could conceivably extend beyond those in the surfing population.  These include prolonged hyper-extension, hyper-coagulable states, anomalous or aberrant arterial supply, embolic propagation, and altered rheology secondary to dehydration.

Speculation is also given to the possibility that this condition could be more common in that sub-clinical events, or those with deficits resolving quickly may not be seen in an acute care setting.

Summary:

  • Surfer’s myelopathy is considered rare but is still more common than lightening strikes and shark attacks.
  • Novice surfer’s may benefit by prophylactic measures such as avoiding sustained hyper-extension, proper hydration, and surfing immediately after a lengthy trip.
  • Some degree of sensory preservation portends recovery and steroids may be helpful in these cases.
  • Chiropractic Neurologists should be familiar with the manifestations of spinal cord infarction as it can occur outside of the surfing population.

 

REFERENCE:

  1. Freedman , Malone DG, Rasmussen PA, Cage JM, Benzel EC.  Surfer’s Myelopathy: A Rare Form of Spinal Cord Infarction in Novice Surfers: A Systematic Review. Neurosurgery. 2016 May;78(5):602-11
  2. Surfer’s Myelopathy- A Rare Form of Spinal Cord Infarction in Novice Surfers- A Systematic Review
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