Pediatric Physiatrist Joe DiMaggio Children's Hospital Hollywood, Florida, United States
Case Diagnosis: Surfer Myelitis
Case Description: A 13-year-old previously-healthy boy presented with acute mid-back pain (10/10 severity) that radiated into both legs after a 3-hour first-time surfing lesion with no trauma. Subsequently, he experienced rapidly progressive lower extremity weakness and one hour later was not able to walk. Lower extremity examination (symmetric bilaterally) revealed 4/5 strength in iliopsoas/quadriceps/hamstrings, 2/5 strength in tibialis anterior and EHL, sensory level L1, decreased vibration sense, and hyperreflexia. Voluntary sphincter contraction was preserved. MRI T/L-spine showed increased T2-signal involving the central cord and cord expansion distal to T7-T8. Patient was started on high-dose intravenous solumedrol. Foley catheterization yielded 900mL output. After 24-hours on steroids, pain and urinary retention improved. He was transferred to inpatient rehabilitation at a min-assist level. Persistent bilateral spastic foot-drop was treated with stretching, AFO, and oral baclofen. After a comprehensive rehabilitation program for 11 days, he was discharged at a supervision to modified-independent level with Loftstrand crutches.
Discussions: This case presents a rare non-traumatic myelopathy known as Surfer’s Myelitis, which is classically seen in young novice surfers as well as gymnasts. It is postulated that there is a vascular etiology, such as spinal cord ischemia following hyperextension of the spine, but the exact mechanism is yet to be established. In the literature, only approximately 70 total cases have been reported globally. Prognosis appears to be correlated with ASIA classification and symptom severity on initial presentation. Rapid treatment with high-dose intravenous steroids is essential to halt disease progression.
Conclusions: Surfer’s myelitis is a rare progressive painful myelopathic syndrome in young, healthy individuals associated with a dramatic acute functional decline. It requires early clinical recognition and intervention; therefore, raised awareness in the medical community is crucial. Timely administration of steroids and admission to inpatient rehabilitation may portend good functional outcomes, but further investigations are needed.