Background

Surfer’s myelopathy is a rare complication of spinal hyperextension originally described in novice surfers. However, reports from patients practicing different activities had risen.

Aim

To systematically synthesize the epidemiological and clinical evidence on acute hyperextension-induced myelopathy (“Surfer's myelopathy”) and propose new diagnostic criteria.

Methods

We systematically searched four databases for all observational and case studies on the topic. We performed a narrative synthesis to propose diagnostic criteria and tested the criteria retrospectively on the included cases. A case report is also presented.

Results

Forty-two articles reporting 104 cases (median age 19 years, slightly male predominance) were included. All cases reported a nontraumatic hyperextension event (58% after surfing). All of the cases presented pain of hyperacute onset. The most frequent clinical feature was bladder or bowel dysfunction (84%). The thoracic region was the most frequently affected (87%) with longitudinal involvement until the conus (67%). At discharge or follow-up, 52% partially recovered. We propose five diagnostic criteria with three levels of certainty (definite, probable, and possible): (1) nontraumatic spine hyperextension activity (in individuals with no pre-existent spinal disease); (2) hyperacute onset (with acute pain onset); (3) spinal cord injury clinic (motor, sensory, or autonomic deficit); (4) MRI findings with central spinal cord abnormalities (multiple segments); and (5) no other alternative diagnosis. We identified 88% definite and 12% probable/possible cases.

Conclusion

The acute hyperextension-induced myelopathy could occur not only during surfing but also during other activities. Therefore, increased awareness and education among sports communities and general physicians are needed.

中文翻译：

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冲浪者的脊髓病是急性过度伸展引起的脊髓病吗？案例研究和提出的诊断标准的系统综合

背景

冲浪者脊髓病是一种罕见的脊柱过伸并发症，最初在新手冲浪者中描述。然而，来自从事不同活动的患者的报告有所增加。

目的

系统综合急性过伸所致脊髓病（“冲浪者脊髓病”）的流行病学和临床证据，提出新的诊断标准。

方法

我们系统地搜索了四个数据库，以获取有关该主题的所有观察和案例研究。我们进行了叙述性综合以提出诊断标准，并对纳入的病例进行回顾性测试。还提交了一份病例报告。

结果

纳入报告 104 例病例（中位年龄 19 岁，男性略多）的 42 篇文章。所有病例均报告了非创伤性过伸事件（冲浪后 58%）。所有病例均呈现超急性发作的疼痛。最常见的临床特征是膀胱或肠道功能障碍（84%）。胸部区域是最常受累的（87%），纵向受累直到圆锥（67%）。在出院或随访时，52% 部分康复。我们提出了五个诊断标准，具有三个确定性级别（确定、可能和可能）：（1）非创伤性脊柱过度伸展活动（在没有预先存在脊柱疾病的个体中）；(2) 超急性发作（急性疼痛发作）；(3) 脊髓损伤门诊（运动、感觉或自主神经功能障碍）；（4）中央脊髓异常（多节段）的MRI表现；(5)无其他替代诊断。我们确定了 88% 的确定病例和 12% 的可能/可能病例。

结论

急性过伸引起的脊髓病不仅可能发生在冲浪期间，也可能发生在其他活动中。因此，需要提高体育界和全科医生的意识和教育。