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Non-Traumatic Paraplegia in a First Time Surfer

Non-Traumatic Paraplegia in a First Time Surfer. CPT Moses H. Cheng CPT Elizabeth A. Durbin Tripler Army Medical Center March 2007. Introduction. Novice surfers with non-traumatic back pain are at increased risk for paraplegia There are potentially catastrophic outcomes of back pain.

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Non-Traumatic Paraplegia in a First Time Surfer

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  1. Non-Traumatic Paraplegia in a First Time Surfer CPT Moses H. Cheng CPT Elizabeth A. Durbin Tripler Army Medical Center March 2007

  2. Introduction • Novice surfers with non-traumatic back pain are at increased risk for paraplegia • There are potentially catastrophic outcomes of back pain

  3. The Case • 37-year old AD male with acute low back pain after attempting surfing for the first time • Pain became severe with transient sensory complaints • Decreased reflexes and unable to ambulate

  4. Arrival at Tripler (6 hours after initial symptoms) • Lower extremity neuro exam • Decreased muscle strength (3/5) • Absent dorsiflexion • Minimal plantarflexion • Intact sensation • Unequal patellar reflexes • Absent Achilles and Babinski • Poor rectal sphincter tone • L-spine plain films and CT L/S-spinenormal

  5. Worsened lower extremity deficits Bilateral strength 1/5 Sensory loss L4 to S5 Hospital Course

  6. Initial MRI • MRI L-spine • Consistent with cord ischemia

  7. MRI at 48 hours • Transferred to ICU • Paraplegia to T11

  8. Discussion • Surfing injuries are primarily traumatic in nature • Contact with surfboard • Collision • Hydrodynamic forces • Impact with the ocean floor • Incidence of head and neck injuries is 34%-37% • Most craniospinal injuries are secondary to impact with the sand or being hit by a surfboard (JAMA, 1977)

  9. Surfer’s Myelopathy Unique syndrome involving a first time surfer who develops non-traumatic back pain and paraparesis with sensory and urinary symptoms

  10. Literature Review • Thompson TP, et al. Spine, 2004. • Case series of 9 patients with non-traumatic paraparesis/paraplegia • All were first time surfers • Gender: 8 male, 1 female • Age: 21-30 years • All had increased signal on MRI from low thoracic vertebra to conus medullaris • One with residual paraplegia

  11. Postulated Mechanism Prolonged prone hyperextension of back and neck can cause ischemia of spinal cord • Infarction of watershed areas of perfusion • Avulsion of perforating vessels • Vasospasm of artery of Adamkiewicz

  12. Why Novice Surfers? • Only 4-5% of time surfing involves wave riding • 50% spent paddling out • 40% spent stationary • Novice surfers spend extensive time lying prone with neck and back hyperextended

  13. What Our Report Adds • Initial symptoms may be delayed in presentation • Our patient developed pain after exiting the water • Our case validates a potential grim prognosis • Previous series had 1 out of 9 with residual paraplegia

  14. Conclusion • Novice surfers are at risk for spinal cord injury • Body position while surfing is a risk factor for cord injury • Early recognition and consultation • Goal to ensure perfusion of cord • Prevention through education of risks and proper technique

  15. Questions?

  16. References • Thompson TP, Pearce J, et al. Surfer’s Myelopathy, Spine. 2004; 29(16): E353-356 • Allen RH, Straehley CJ, et al. Surfing Injuries at Waikiki, JAMA. 1977; 237: 668-670 • Hartung GH, Goebert DA, et al. Epidemiology of Ocean Sports-Related Injuries in Hawaii, Hawaii Medical Journal. 1990; 49(2): 52-56 • Nathason A, Haynes P, Galanis D. Surfing Injuries, Am J Emerg Med. 2002; 20(3):155-160 • Nathason A, Bird S, Dao Lealand, Tam-Sing K. Competitive Surfing Injuries: A Prospective Study of Surfing Related Injuries Among Contest Surfers, Am J of Sports Med. 2007; 35:115-117 • Sunshine S. Surfing Injuries, Curr Sports Med Rep. 2003; 2(3): 136-141 • Taylor KS, Zoltan TB, Achar SA. Medical Illness and Injuries Encountered During Surfing, Curr Sports Med Rep. 2006; 5(5): 262-267 • Taylor DM, Bennett D, et al. Acute Injury and Chronic Disability Resulting from Surfboard Riding, J Sci Med Sport. 2004; 7(4): 429-437 • Cheshire WP, Santos CC, et al. Spinal Cord Infarction: Etiology and Outcome, Neurology. 1996; 47(2): 321-330 • Novy J, Carruzzo A, et al. Spinal Cord Ischemia: Clinical and Imaging Patterns, Pathogenesis, and Outcomes in 27 Patients, Arch Neurol. 2006; 63:1113-1120 • Mendez-Villanueva A, Bishop D. Physiological Aspects of Surfboard Riding Performance, Sports Med. 2005; 35(1): 55-70

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