1242 - First Timer: A Rare Case of Surfer's Myelopathy in a Pediatric Patient

Case Diagnosis: Surfer’s Myelopathy

Case Description: A 16-year-old male with unremarkable history presented to the emergency department for difficulty ambulating, paresthesia, low back pain, urinary retention, decreased rectal tone. Patient was on vacation in Hawaii and attempted to surf for the first time. No reported trauma occurred while patient was in the water. 2 hours after returning from surfing, he developed an acute onset unilateral extremity weakness and lower back pain. A few hours later, symptoms progressed to inability to ambulate. Bowel, bladder, and sensory changes occurred in parallel. MRI was notable for an abnormal T2 hyperintense and mildly expanded signal in the central spinal cord extending from T8 through the conus medullaris. Subsequently, the patient was transferred to the Neuro ICU to maintain mean arterial pressure goal > 85 mmHg. Foley catheter was placed for urinary retention. Upon medical stabilization, the patient was admitted to an acute rehabilitation unit.

Discussions: Surfer’s myelopathy is a rare, non-traumatic spinal cord injury stemming from prolonged periods of hyperextension. This positioning emphasized in surfing injuries the artery of Adamkiewicz - via dynamic compression, thrombosis, and vasospasms. Thus, the sequelae develops similarly to that of typical anterior spinal artery syndromes. Upon admission to rehab, patient was AIS B and moderate to maximal assist across most ADLs, bed mobility, and transfers. He was discharged after 3-weeks of intensive rehabilitation with a physiatry-led multidisciplinary team as an AIS D, and independent at a wheelchair level.

Conclusions: This case study highlights the importance of acute rehabilitation and interdisciplinary management in a rare case of non-traumatic spinal cord injury. Important modalities utilized by therapists included neuromuscular electrical stimulation, which facilitated functional motor recovery. He was also discharged with a robust continuity of care plan with outpatient therapy, the Perfect Step program, and multidisciplinary physician management to continue on his recovery journey.