A Case of Surfer’s Myelopathy– Insights Into Early Management Leading to Radiographic and Neurologic Improvement
Joo Won Choi1, Nathaniel Villanueva1, Dylan Singh1, Sarah Bellatti1, Ferdinand Hui2, Stacy Brown2
1University of Hawaii John A. Burns School of Medicine, 2The Queen's Medical Center, Neuroscience Institute
Objective:
To describe the first reported case of surfer’s myelopathy for which emergent angiography and early perfusion-based therapy were performed, yielding mechanistic insight and rarely reported functional improvement from complete paraplegia.
Background:
Surfer’s myelopathy (SM) is a rare, non-traumatic spinal cord injury affecting healthy, novice surfers. Although spinal cord ischemia is a suspected mechanism, few reports of spinal angiography have been performed in SM patients. Recovery from complete motor loss is rare as effective treatment strategies have yet to be determined.
Results:
We report the case of a 30-year-old male who developed acute complete paraplegia following his first surfing lesson in Hawaii. Initial MRI demonstrated diffuse T2 hyperintensity in watershed zones from the mid-thoracic spine to the conus medullaris. The patient underwent spinal angiography within 10-hours of injury and spinal perfusion pressure optimization through MAP augmentation and CSF drainage within 24 hours. Spinal angiogram demonstrated disconnection of the right radicular artery at T12 to the ASA. The left T12 radicular artery fed across midline to the right T12 arcade to supply the artery of Adamkiewicz. The craniad ASA did not fill from the AKA. On day 14 prior to discharge, MRI showed significantly improved T2 hyperintensity from T5 through the conus medullaris. Clinically, he demonstrated proximal hip flexion and abduction and trace toe movements. The patient continued to experience improvement, walking with assistance by 3 months post-injury, and walking independently with forearm crutches at 6 months.
Conclusions:
This is a rare case of surfer's myelopathy following complete motor loss in which the patient made functional neurologic recovery with significant reversal of radiographic findings. Our clinical strategy including emergent spinal angiography and early spinal perfusion-based therapy yielded mechanistic insights and promising outcomes. This experience supports change in the standard of care for surfer’s myelopathy to include emergent initiation of diagnostic and therapeutic strategies.