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Is Surfer’s myelopathy an acute hyperextension-induced myelopathy? A systematic synthesis of case studies and proposed diagnostic criteria

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Abstract

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.

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The supplementary material includes extra information. If more information is needed, please contact the corresponding authors.

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Funding

The present study was self-funded by the authors.

Author information

Authors and Affiliations

  1. Servicio de Neurología, Departamento de Medicina y Oficina de Apoyo a la Docencia e Investigación (OADI), Hospital Daniel Alcides Carrión, Callao, Perú

    Carlos Alva-Díaz, Tatiana Metcalf, Nicanor Mori & Roberto Romero-Sanchez

  2. Grupo de Investigación Neurociencia, Efectividad Clínica y Salud Pública, Universidad Científica del Sur, Lima, Perú

    Carlos Alva-Díaz, Ethel Rodriguez-López & Victor Velásquez-Rimachi

  3. Facultad de Medicina, Universidad Nacional Mayor de San Marcos, Lima, Perú

    Ethel Rodriguez-López, Angélica López-Saavedra & Nicanor Mori

  4. Red de Eficacia Clínica y Sanitaria, REDECS, Lima, Perú

    Ethel Rodriguez-López, Angélica López-Saavedra, Tatiana Metcalf, Cristian Morán-Mariños, Victor Velásquez-Rimachi & Wilfor Aguirre-Quispe

  5. Unidad de Investigación en Bibliometría, Universidad San Ignacio de Loyola, Lima, Perú

    Cristian Morán-Mariños

  6. Facultad de Medicina, Universidad Nacional Federico Villarreal, Lima, Peru

    Alba Navarro-Flores

  7. Instituto Nacional de Ciencias Neurológicas, Lima, Peru

    Wilfor Aguirre-Quispe

  8. Neuromodulation Center and Center for Clinical Research Learning, Spaulding Rehabilitation Hospital and Massachusetts General Hospital, Harvard Medical School, Boston, MA, USA

    Emad S. Shaikh & Kevin Pacheco-Barrios

  9. Unidad de Investigación para la Generación y Síntesis de Evidencias en Salud, Vicerrectorado de Investigación, Universidad San Ignacio de Loyola, 550 La Fontana Avenue, La Molina, 15024, Lima, Perú

    Kevin Pacheco-Barrios

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  1. Carlos Alva-Díaz
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  2. Ethel Rodriguez-López
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  3. Angélica López-Saavedra
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  4. Tatiana Metcalf
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  5. Cristian Morán-Mariños
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  7. Victor Velásquez-Rimachi
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  9. Emad S. Shaikh
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  10. Nicanor Mori
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  11. Roberto Romero-Sanchez
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  12. Kevin Pacheco-Barrios
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Contributions

A-DC, L-SA, R-LE, and NM designed the case report; M-MC and N-FA provided the method to develop the systematic review; L-SA, R-LE, and N-FA independently screened titles and abstracts for relevance, assessed full texts for inclusion, and carried out data extraction; M-MC, A-DC, and P-BK conducted the formal analysis; A-DC, R-LE, L-SA, M-MC, N-FA, and P-BK drafted the manuscript; A-DC, V-RV, AW, ESS, MN, and R-SR provided clinical corrections; A-DC, P-BK, V-RV, and MT revised the manuscript and did systematic review; MT, ESS, N-FA, and P-BK helped in the translation, editing, and proofing of the manuscript and contributed to the method report and systematic review. All authors provided critical revisions to the manuscript.

Corresponding author

Correspondence to Kevin Pacheco-Barrios.

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Conflicts of interest

The authors declare no conflicts of interest.

Ethics approval

For reporting the clinical case, the authors receive approval from the Institutional Review Board of “Daniel Alcides Carrión” Hospital, Lima, Peru.

Consent to participate

The index patient provided his informed consent to participate in the case report.

Consent for publication

The patient provided consent for publication of the case report.

Supplementary Information

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Alva-Díaz, C., Rodriguez-López, E., López-Saavedra, A. et al. Is Surfer’s myelopathy an acute hyperextension-induced myelopathy? A systematic synthesis of case studies and proposed diagnostic criteria. J Neurol 269, 1776–1785 (2022). https://doi.org/10.1007/s00415-021-10775-4

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  • DOI: https://doi.org/10.1007/s00415-021-10775-4

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