Disclosures: Kevin J. Cipriano, MD: No financial relationships or conflicts of interest

Case Description: A 56 year old female without significant PMH presented with ascending tingling/numbness to her bilateral knees after high intensity workout with explosive lumbar hyper-extension movements. She also reported right leg weakness. Patient denied recent illness in the past 2 months including diarrhea and URI, vaccines, sick contacts, or travel. She was treated with IVIG 2g/kg over 5 days. Workup showed infarction of the conus medullaris on Spinal MRI/MRA resulting in incomplete paraplegia (L3 AIS D) with unremarkable Lumbar Puncture.

Setting: Inpatient Rehabilitation Facility

Patient: 56 Year-old Female without significant PMH presenting with incomplete paraplegia (L3 AIS D). Assessment/

Results: CT head, CTA head/neck, and MRI cord compression were all unremarkable. A spine MRI with and without contrast and a spine MRA with and without contrast were conducted. The MRI demonstrated increased T2 signal centrally at the conus medullaris without associated abnormal enhancement. The MRA demonstrated restricted diffusion in the conus medullaris, consistent with spinal cord infarction. Through inpatient rehabilitation, patients improved to RLE 4+ DF, 4 EHL, 4+PF, 3 Eversion, b/l LE numbness from the ankles and distally. Patient ambulating with a SPC on discharge.

Discussion: Surfer’s Myelopathy (SM) is a rare entity, defined by non-traumatic paraplegia associated with spine hyperextension in surfers. It is postulated that the excessive and/or repetitive spine hyperextension associated with surfing causes an ischemic insult to the distal spinal cord. The exact mechanism by which the ischemic event occurs is still unclear.

Conclusion: We believe the importance of this case is to illustrate potential inciting events that can lead to transient spinal cord ischemia. Possible mechanisms such as vasospasm or avulsion of perforating spinal cord arteries appear to be possible through repetitive hyperextension exercises. It appears this syndrome can occur with prolonged and/or explosive lumbar hyperextension movements, not just limited to the prolonged prone nature and hyperextension seen with surfing.

Level of Evidence: Level V

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PM&R Meeting Abstracts - https://pmrjabstracts.org/abstract/nontraumatic-acute-hyperextension-myelopathy-associated-with-weight-lifting-surfers-myelopathy/