1144 - Surfer’s Myelopathy: A Rare Case of Complete Spinal Cord Injury

18-year-old male with no past medical history presented to the emergency department with acute onset lower back pain, weakness in bilateral lower extremities, sensory changes, and urinary retention following a surfing lesson. He was diagnosed with dehydration, treated with IV fluids and discharged. The patient returned the next day due to inability to walk and decreased sensation in his legs. MRI showed demyelination vs. inflammatory myelopathy at T9-T12. The patient was ultimately diagnosed with Surfer’s Myelopathy and started on IV solmedrol. In acute rehabilitation, International Standards for Neurological Classification of Spinal Cord Injury (ISNCSCI) exam revealed a neurologic level of T11 AIS A. Under the care of spinal cord injury (SCI) specialized physiatrists, the patient established successful bowel and bladder programs and adapted to new functional status.

Discussions:

“Surfer’s Myelopathy” is a rare nontraumatic SCI with just over 100 cases reported. It is most commonly observed in novice surfers, but can occur after any repeated hyperextension of the spine. The most commonly proposed mechanism is ischemic injury. Our patient meets the newly proposed diagnostic criteria including: nontraumatic hyperextension, symptom onset within 4 hours, clinical signs of SCI, central spinal cord abnormalities on MRI, and exclusion of alternative diagnoses. Severity of SCI at admission may be most predictive of neurologic outcome and SCI trained physiatrists are uniquely equipped to guide prognosis and optimize outcomes. However, nearly one-third of case reports fail to document an ISNCSCI exam and rehabilitation management is rarely discussed. Our patient suffered a complete SCI and benefitted from specialized SCI rehabilitation.

Conclusions: Surfer’s myelopathy should be considered in patients with no previous SCI with acute back pain and progressive neurological deficits following hyperextension activity. Rehabilitation under SCI trained physiatrists is essential to promote functional outcomes in this patient population.