Spinal cord decompression sickness in sport diving

Abstract

Objective: To summarize 16 years' experience in the diagnosis and treatment of spinal cord decompression sickness in Israel.

Design: The survey data were collected firsthand by physicians trained in underwater diving medicine.

Setting: The Israeli Naval Medical Institute, Israel's national hyperbaric referral center.

Patients: Sixty-eight sport divers diagnosed as having spinal cord decompression sickness.

Interventions: Hydration and 100% oxygen breathing until the patient reached the hyperbaric chamber. All patients received recompression therapy on US Navy treatment tables using oxygen, except for six who were treated by Comex Treatment Table CX-30, which uses helium in addition to oxygen.

Main outcome measures: Neurological examination after the completion of recompression therapy.

Results: Forty-one percent of the dives were performed within the decompression limits of the US Navy standard decompression tables. Risk factors were fatigue, circumstances suggesting dehydration, and extreme physical effort. The most common presenting symptoms were paresthesias, weakness of the legs, lower back pain, or abdominal pain. Full recovery was achieved in 79% of the patients. Spinal symptoms appeared immediately on surfacing in six of the eight patients who continued to have multiple neurological sequelae.

Conclusions: United States Navy air decompression tables appear not to be completely safe for sport divers. Even mild spinal symptoms identified on surfacing should be treated vigorously. High-pressure oxygen-helium therapy seems to be a promising alternative in cases of severe spinal cord decompression sickness.