(Kiosk 6) Pediatric Rehabilitation of Acute Hyperextension-induced Myelopathy After Surfing: A Case Report

Case Diagnosis: A 13-year-old boy with past medical history of hypothyroidism

Case Description or Program Description: The patient presented to the emergency room after his first surfing lesson while visiting Hawaii. At baseline, the patient was athletic and played multiple sports. He had a surfing lesson that lasted about 1 hour. About 30 minutes into the lesson, he developed lower back pain. 1 hour after completing the lesson, the patient’s pain became severe and he developed lower extremity weakness with dysesthesias. He did not recall any particular traumatic event during the surfing lesson. In the emergency room, the patient had significant lower extremity paresis with only minimal hip flexion bilaterally. He also was found to have significant urinary retention. Sensation was preserved at the T10 level.

Setting: Inpatient pediatric rehabilitation unit

Assessment/Results: MRI of the thoracic spine without contrast was significant for T2 hyperintense signal in the T9-T12 distal thoracic cord. The patient was diagnosed with surfer’s myelopathy, or more recently described as acute hyperextension-induced myelopathy (AHIM). He was given dexamethasone and received blood pressure augmentation with intravenous vasopressors. The patient was downgraded and traveled back home to undergo rehabilitation. Upon admission, the patient required moderate assistance to perform transfers and walked 56.7 feet with minimal assistance using a rolling walker. He required maximal assistance for toileting. The patient completed a 10-day inpatient rehabilitation program and experienced exceptional improvement in functional mobility. He progressed to ambulating 1000 feet with supervision or contact guard assist with a gait belt and transferred independently. All ADLs were performed at a modified independent level.

Discussion (relevance): AHIM is a rare phenomenon triggered by repetitive spinal hyperextension. While there are studies describing this clinical syndrome in detail, the literature lacks details about rehabilitation outcomes for these patients.

Conclusions: Following diagnosis and acute management of AHIM, a comprehensive inpatient rehabilitation program should be implemented for maximal functional improvement.