Spinal cord decompression sickness in sport diving
J. Aharon-Peretz, Y. Adir, C. R. Gordon, S. Kol, N. Gal and Y. Melamed
Department of Neurology, Rambam Medical Center, Haifa, Israel.
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.
