Alva-Díaz Carlos, Rodriguez-López Ethel, López-Saavedra Angélica, Metcalf Tatiana, Morán-Mariños Cristian, Navarro-Flores Alba, Velásquez-Rimachi Victor, Aguirre-Quispe Wilfor, Shaikh Emad S, Mori Nicanor, Romero-Sanchez Roberto, Pacheco-Barrios Kevin
Servicio de Neurología, Departamento de Medicina y Oficina de Apoyo a la Docencia e Investigación (OADI), Hospital Daniel Alcides Carrión, Callao, Perú.
Grupo de Investigación Neurociencia, Efectividad Clínica y Salud Pública, Universidad Científica del Sur, Lima, Perú.
J Neurol. 2022 Apr;269(4):1776-1785. doi: 10.1007/s00415-021-10775-4. Epub 2021 Sep 3.
Surfer's myelopathy is a rare complication of spinal hyperextension originally described in novice surfers. However, reports from patients practicing different activities had risen.
To systematically synthesize the epidemiological and clinical evidence on acute hyperextension-induced myelopathy ("Surfer's myelopathy") and propose new diagnostic criteria.
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.
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.
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.
冲浪者脊髓病是脊柱过伸的一种罕见并发症，最初在新手冲浪者中被描述。然而，来自从事不同活动患者的报告有所增加。
系统综合关于急性过伸性脊髓病（“冲浪者脊髓病”）的流行病学和临床证据，并提出新的诊断标准。
我们系统检索了四个数据库，以查找关于该主题的所有观察性研究和病例报告。我们进行了叙述性综合分析以提出诊断标准，并对纳入的病例进行回顾性标准测试。还呈现了一份病例报告。
纳入了42篇报告104例病例的文章（中位年龄19岁，男性略占优势）。所有病例均报告了非创伤性过伸事件（58%发生在冲浪后）。所有病例均表现为超急性发作的疼痛。最常见的临床特征是膀胱或肠道功能障碍（84%）。胸椎区域是最常受累的部位（87%），纵向累及直至圆锥（67%）。在出院或随访时，52%的患者部分恢复。我们提出了五个诊断标准，分为三个确定程度级别（明确、很可能、可能）：（1）非创伤性脊柱过伸活动（在无既往脊柱疾病的个体中）；（2）超急性发作（急性疼痛发作）；（3）脊髓损伤临床表现（运动、感觉或自主神经功能缺损）；（4）MRI显示脊髓中央异常（多个节段）；（5）无其他替代诊断。我们确定了88%的明确病例和12%的很可能/可能病例。
急性过伸性脊髓病不仅可发生在冲浪期间，也可发生在其他活动期间。因此，体育团体和普通医生需要提高认识并加强教育。
