1. Is Surfer's myelopathy an acute hyperextension-induced myelopathy? A systematic synthesis of case studies and proposed diagnostic criteria.
- Author
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Alva-Díaz C, Rodriguez-López E, López-Saavedra A, Metcalf T, Morán-Mariños C, Navarro-Flores A, Velásquez-Rimachi V, Aguirre-Quispe W, Shaikh ES, Mori N, Romero-Sanchez R, and Pacheco-Barrios K
- Subjects
- Adult, Humans, Male, Retrospective Studies, Young Adult, Spinal Cord Diseases diagnostic imaging, Spinal Cord Diseases etiology, Spinal Cord Injuries complications, Spinal Cord Ischemia complications, Spinal Cord Ischemia diagnosis, Sports
- 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., (© 2021. Springer-Verlag GmbH Germany, part of Springer Nature.) more...
- Published
- 2022
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