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Abstract Details

Prolonged Back Hyperextension in Surfer’s Myelopathy Patients Supports Positional Spinal Ischemia as a Mechanism of Injury
Neuro Trauma and Critical Care
P3 - Poster Session 3 (11:45 AM-12:45 PM)
4-001

Systematically characterize the predisposing conditions contributing to the risk of Surfer’s Myelopathy (SM).

SM is a rare, non-traumatic spinal cord injury that affects novice surfers. Described clinical and radiographic features are highly suggestive of spinal ischemic stroke. The observed difference in idling positions between novice (prone with back hyperextended) and experienced surfers (sitting up on the surfboard) has generated the hypothesized pathogenesis of position-induced spinal vascular insufficiency. However, existing data is limited to retrospective case reports recalling variable information.
Patients 14+ years with an SM diagnosis are enrolled in an ongoing, prospective longitudinal study. Study participation includes a detailed questionnaire on symptom development and situational exposures, clinical data, and long-term follow-up measures.
Eleven patients (10 males) ages 16-39 years (median age 23) were enrolled between 2021-2024. All patients presented during or shortly after their first surf lesson. 0/11 had heard of SM before their diagnosis or were briefed on the risk by their surf instructor. Notable findings from the history questionnaire include prolonged time spent in the prone, hyperextended position (7/10 reported prone positioning for greater than 45 consecutive minutes). Patients’ first symptom is often low back pain (7/10), and symptomatic progression to the inability to walk occurs rapidly, most often over 30-60 minutes (6/9) or within 30 minutes (3/9). In one patient, diagnostic angiography with positional examinations revealed that normal flow through a vertebral artery (supplying the anterior spinal artery craniad) was observed to disappear in the hyperextended position.
The prolonged prone positioning reported by SM patients notably contrasts with techniques experienced surfers utilize. Considering that formal surf instruction was the common injury setting for all patients, incorporating preventive advice (i.e., sitting up on the surfboard while idling) into surf lessons may be the most effective strategy for reducing rates of SM.
Authors/Disclosures
Joo Won Choi, MD
PRESENTER 		Mr. Choi has nothing to disclose.
Sarah E. Bellatti Ms. Bellatti has nothing to disclose.
Eli Snyder Eli Snyder has nothing to disclose.
Liza Rooks (John A. Burns School of Medicine) Ms. Rooks has nothing to disclose.
Kazuma Nakagawa, MD, FAAN (The Queen'S Medical Center) Dr. Nakagawa has nothing to disclose.
Ferdinand Hui (The Queen's Medical Center, Neuroscience Institute) No disclosure on file
Jessica Wilson, PhD Dr. Wilson has nothing to disclose.
Stacy C. Brown, MD (The Queen's Medical Center, Neuroscience Institute) Dr. Brown has nothing to disclose.