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1274 - Wipeout! Boogie Boarding's Unexpected Cervical Catastrophe

Friday, February 28, 2025

5:00 PM - 6:30 PM MST

Corresponding Author(s)

AB

Alon Bezalel, DO

Medical student
Nassau university medical center
Flushing, New York, United States

Co-Author(s)

BF

Brent Fogel, DO

Resident Physician
Nassau University Medical Center
East Meadow, New York, United States

Presenting Author(s)

CK

Chi Lam Kwok, DO

Resident Physician
Nassau University medical center
Rego park, New York, United States

Co-Author(s)

JW

Justin Wang, MD

Resident Physician
Nassau University Medical Center
East Meadow, New York, United States
FB

Forrest Butensky, DO

Resident Physician
Nassau University Medical Center
East Meadow, New York, United States
RC

Ricardo Cruz, MD, MD

Director
Mount Sinai South Nassau Rehabilitation Department
Plainview, New York, United States

Case Diagnosis: A 62-year-old male with an ASIA A spinal cord injury, anterior longitudinal ligament disruption at C3-C4 level, severe cervical stenosis at multiple levels, and acute cord compression.

Case Description:

A 62-year-old male presented with an injury that occurred during a boogie-boarding accident when the patient struck his head on the sand, leading to immediate neurological deficits without loss of consciousness. Initial management involved spinal precautions, administration of intravenous fluids, vasopressors, and emergent imaging that included CT and MRI scans. Surgical intervention included a partial C2 laminectomy, C3-C6 laminectomies, and C2-T1 posterior lumbar interbody fusion aimed at decompressing the spinal cord. Post-operatively day 1, the patient exhibited complete sensory loss below the T4 level and tetraplegia. By post-operative day 7, there were minor signs of neurological improvement, including minimal voluntary shoulder flexion, the ability to wiggle the left toes and wiggle fingers, pronate, and supinate both hands, although significant sensory deficits persisted. The ability to swallow on command was present showing some preservation of cranial nerve functions.

Discussions:

Early intervention in spinal cord injury management is critical to preserving neural function and enhancing recovery. Respiratory dysfunction, particularly in injuries above the T6 level, requires vigilant management to prevent complications like pneumonia. Autonomic dysreflexia, spasticity, pain, and pressure ulcers, bowel and bladder dysfunctions need meticulous care and strict monitoring. A holistic approach encompassing vocational rehabilitation and adaptations for daily living is essential for community reintegration and improved quality of life.

Conclusions:

This case underscores the imperative for swift diagnosis and intervention in cervical spine injuries. The patient's severe presentation necessitated extensive surgical decompression and management of secondary injuries. Despite profound initial deficits, observable minor neurological improvements post-surgery underscores the potential for some recovery. This report reinforces the necessity of acute medical, surgical and sustained rehabilitation strategies for improving quality of life and fostering independence in patients.