title: Surfers' myelopathy: a case series of 19 novice surfers with nontraumatic myelopathy.
abstract: OBJECTIVE
  We report the clinical characteristics of the largest series of nontraumatic spinal cord injury in novice surfers (surfers' myelopathy).
  
  
  METHODS
  A retrospective review of the electronic medical record was performed in patients with nontraumatic spinal cord injury associated with surfing identified upon admission to the largest tertiary referral hospital in Hawaii from June 2002 to November 2011. Classification by the American Spinal Injury Association Impairment Scale (AIS) was performed upon admission and at follow-up. Clinical management, including blood pressure measurements and optimization, use of corticosteroids, and diagnostic evaluations, were reviewed. Follow-up information was obtained by clinic visits, telephone interviews, and electronic mail up to 3 years after injury.
  
  
  RESULTS
  In 19 patients (14 male) aged 15-46 years, all patients complained of sudden onset of low back pain while surfing, followed by bilateral leg numbness and paralysis progressing over 10-60 minutes. All patients were novice surfers; 17 of 19 were surfing for the first time. On T2-weighted MRI, all patients had hyperintensity from the lower thoracic spinal cord to the conus medullaris. Six of 10 patients who underwent spinal diffusion-weighted MRI showed restricted diffusion in this region. Patients presenting with worse AIS scores had minimal improvement at follow-up. Blood pressure, corticosteroids, and imaging results were not associated with severity of neurologic deficits at follow-up.
  
  
  CONCLUSIONS
  Although the cause of surfers' myelopathy is unclear, the rapid onset and presence of restricted diffusion suggest ischemic injury. Admission severity appears to be most predictive of neurologic outcome.
authors.affiliation: The Queen's Medical Center, Honolulu, Hawaii, USA. cchang@queens.org
authors.forename: Cherylee W J
authors.initials: CW
authors.lastname: Chang
authors.forename: Daniel J
authors.initials: DJ
authors.lastname: Donovan
authors.forename: Leon K
authors.initials: LK
authors.lastname: Liem
authors.forename: Kristine H
authors.initials: KH
authors.lastname: O'Phelan
authors.forename: Deborah M
authors.initials: DM
authors.lastname: Green
authors.forename: Sarice
authors.initials: S
authors.lastname: Bassin
authors.forename: Susan
authors.initials: S
authors.lastname: Asai
mesh_terms: D000293:Adolescent; D000328:Adult; D001265:Athletic Injuries / Q000150:complications* / Q000175:diagnosis* / Q000188:drug therapy; D005260:Female; D005500:Follow-Up Studies; D006254:Hawaii; D006801:Humans; D017116:Low Back Pain / Q000175:diagnosis / Q000188:drug therapy / Q000209:etiology; D008297:Male; D008875:Middle Aged; D012189:Retrospective Studies; D013119:Spinal Cord Injuries / Q000175:diagnosis* / Q000188:drug therapy / Q000209:etiology*; D055815:Young Adult