Department of Orthopedics, Wuhan Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China.
Department of Orthopedics, Wuhan Children's Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China.
World Neurosurg. 2021 Apr;148:e227-e241. doi: 10.1016/j.wneu.2020.12.135. Epub 2021 Jan 5.
The cause of surfer myelopathy remains enigmatic and long-term follow-up outcomes are not well documented. In the present study, the mechanisms underlying surfer myelopathy in children are analyzed and the long-term follow-up outcomes are reported.
Clinical data from 3 institutions were retrospectively analyzed. Patients were assessed using the American Spinal Injury Association Impairment Scale (AIS) on admission and at follow-up. The mechanisms were studied by analyzing patients' medical history, magnetic resonance imaging, and magnetic resonance angiography. The prognosis of long-term follow-up was summarized.
Thirty-one children were diagnosed with surfer myelopathy. Intramedullary high-intensity T2 signal from mid to lower thoracic level to conus was found during the acute stage. Follow-up magnetic resonance imaging in the subacute stage showed cranial progression of the T2 hyperintensity up to 1-10 vertebral segments, and no neurologic deterioration was found. Intramedullary lesion length between the complete and incomplete injury was significantly different (P < 0.01) in the subacute phase. Flow voids around nerve roots and in the epidural space were detected in 18 patients and 15 patients, respectively, on axial T2-weighted imaging. Enlarged tortuous veins were found in 3 of 6 patients who underwent spinal magnetic resonance angiography, which were discontinuous around nerve root. During long-term follow-up, no patients with AIS grade A recovered, and atrophic cord was observed in the later stage in 14 patients. Patients with incomplete injury had different recoveries.
Surfer myelopathy in children is caused by spinal venous hypertension. The AIS grade on admission is a predictor of prognosis.
冲浪者脊病的病因仍然扑朔迷离，长期随访结果也没有很好的记录。本研究分析了儿童冲浪者脊病的发病机制，并报告了长期随访结果。
回顾性分析 3 家机构的临床资料。患者入院时和随访时采用美国脊髓损伤协会损伤分级（AIS）进行评估。通过分析患者的病史、磁共振成像（MRI）和磁共振血管造影（MRA）来研究发病机制。总结长期随访的预后。
31 例儿童被诊断为冲浪者脊病。在急性期发现从胸段中部到下部至圆锥的髓内高强度 T2 信号。亚急性期的随访 MRI 显示 T2 高信号向颅侧进展 1-10 个椎体节段，且无神经功能恶化。亚急性期完全和不完全损伤的髓内病变长度差异有统计学意义（P<0.01）。18 例患者在轴位 T2 加权成像上发现神经根周围和硬膜外间隙的血流空影，15 例患者发现神经根周围和硬膜外间隙的血流空影。6 例患者行脊髓 MRA 检查，发现 3 例有增粗迂曲的静脉，且围绕神经根不连续。长期随访中，无 AIS 分级 A 患者恢复，14 例患者后期观察到脊髓萎缩。不完全损伤患者的恢复情况不同。
儿童冲浪者脊病是由脊髓静脉高压引起的。入院时的 AIS 分级是预后的预测因素。
