Choi June Ho, Ha Jung-Ki, Kim Chung Hwan, Park Jin Hoon
Department of Neurological Surgery, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea.
Department of Orthopaedic Surgery, Gangneung Asan Hospital, University of Ulsan College of Medicine, Gangneung, Korea.
J Korean Neurosurg Soc. 2018 Nov;61(6):767-773. doi: 10.3340/jkns.2017.0262. Epub 2018 Oct 30.
Three male patients diagnosed with surfer's myelopathy (19-30 years) were admitted to our hospital. All three patients were novice surfers showing a typical clinical course of rapid progression of paraplegia following the onset of back pain. Typical history and magnetic resonance imaging features indicated the diagnosis of surfer's myelopathy. Two patients received high-dose steroid therapy and the other was treated with induced hypertension. One patient treated with induced hypertension showed almost full recovery; however, two patients who received high-dose steroid therapy remained completely paraplegic and required catheterization for bladder and bowel dysfunction despite months of rehabilitation. Our case series demonstrates the potentially devastating neurological outcome of surfer's myelopathy; however, early recovery in the initial 24-72 hours of presentation can occur in some patients, which is in accordance with previous reports. Ischemic insult to the spinal cord is thought to play a crucial role in the pathophysiology of surfer's myelopathy. Treatment recommendations include hydration, induced hypertension, early spinal angiography with intra-arterial intervention, intravenous tissue plasminogen activator, and high-dose steroid therapy; however, there is no standardized treatment option available. Early recovery appears to be important for long-term neurological outcome. Induced hypertension for initial treatment can be helpful for improving spinal cord perfusion; therefore, it is important for early and long-term neurological recovery. Education and awareness are essential for preventing surfer's myelopathy and avoiding further deterioration of neurological function.
三名被诊断为冲浪者脊髓病的男性患者（年龄在19至30岁之间）被收治入院。这三名患者均为冲浪新手，表现出典型的临床病程，即背痛发作后截瘫迅速进展。典型的病史和磁共振成像特征提示了冲浪者脊髓病的诊断。两名患者接受了大剂量类固醇治疗，另一名患者接受了诱导性高血压治疗。一名接受诱导性高血压治疗的患者几乎完全康复；然而，两名接受大剂量类固醇治疗的患者仍然完全截瘫，尽管经过数月的康复治疗，仍因膀胱和肠道功能障碍需要导尿。我们的病例系列证明了冲浪者脊髓病可能造成的毁灭性神经学后果；然而，一些患者在出现症状的最初24至72小时内可能会早期恢复，这与先前的报道一致。脊髓缺血性损伤被认为在冲浪者脊髓病的病理生理学中起关键作用。治疗建议包括补液、诱导性高血压、早期脊髓血管造影及动脉内干预、静脉注射组织纤溶酶原激活剂和大剂量类固醇治疗；然而，目前尚无标准化的治疗方案。早期恢复似乎对长期神经学预后很重要。初始治疗采用诱导性高血压有助于改善脊髓灌注；因此，对早期和长期神经学恢复很重要。教育和提高认识对于预防冲浪者脊髓病和避免神经功能进一步恶化至关重要。
