Got vertebral degenerative changes? Your risk for spinal cord DCS may be elevated.+

[DocVikingo]

“Spinal Cord. 2013 Oct 15. doi: 10.1038/sc.2013.121. [Epub ahead of print]

Relation between cervical and thoracic spinal canal stenosis and the development of spinal cord decompression sickness in recreational scuba divers.

Gempp E, Louge P, Lafolie T, Demaistre S, Hugon M, Blatteau JE.

Source: Diving and Hyperbaric Medicine Department, Sainte Anne's Military Hospital, Toulon Cedex 9, France.

Abstract

Study design: Retrospective case-control study.

Objectives: The intent of this study was to investigate the relationships between vertebral degenerative changes resulting in spinal canal stenosis, spinal cord lesions and the development of spinal cord decompression sickness (DCS) in scuba divers.

Setting: Referral hyperbaric facility, Toulon, France.

Methods: We examined 33 injured divers less than 50 years old by cervical and thoracic MRI and compared them with 34 matched control divers. The number of intervertebral disk abnormalities and the degree of canal compression were analyzed on T2-weighted sagittal images using a validated grading system developed recently. The presence and the distribution of hyperintense cord lesions in relation with the accident and the recovery status at 6 months were also assessed.

Results: Canal spinal narrowing was more common in injured divers than in controls (79% vs 50%, OR=3.7 [95% CI, 1.3-10.8], P=0.021). We found a significant linear association between the extent of canal stenosis, multisegmental findings and the development of spinal cord decompression sickness. MRI intramedullary lesions were significantly more frequent in divers with incomplete recovery (OR=16 [95% CI, 2.6-99], P=0.0014), but statistical analysis failed to demonstrate a significant relationship between canal compression, signal cord abnormalities and a negative clinical outcome.

Conclusions: These results suggest that divers with cervical and thoracic spinal canal stenosis, mainly due to disk degeneration, are at increased risk for the occurrence of spinal cord decompression sickness.”​

 

[button]

Is there any data that suggests someone is at risk based on the location of the degenerative disk disease? It seems like so many people have problems in the lumbar region that it's almost considered normal.

 

[DocVikingo]

Is there any data that suggests someone is at risk based on the location of the degenerative disk disease? It seems like so many people have problems in the lumbar region that it's almost considered normal.

Hi Button,

Lumbar spinal stenosis is in fact more common than cervical spinal stenosis, but the latter is very often the more worrisome as, unlike lumbar stenosis, it involves compression of the actual spinal cord.

As you can see from the below graphic, the spinal cord is not present in the lumbar spine --> http://www.csuchico.edu/~pmccaffrey/syllabi/CMSD 320/images/SpinalCord2.JPG

Regards,

DocVikingo

This is educational only and does not constitute or imply a doctor-patient relationship. It is not medical advice to you or any other individual and should not be construed as such.

 

[boulderjohn]

Have you seen more than the abstract?

Not being a doctor, I am having some trouble understanding the methodology and the degree to which the results are significant. To what degree does this indicate an increased threat? If I am a diver with known cervical stenosis, how will this knowledge affect my dive planning?

 

[button]

Have you seen more than the abstract?

Not being a doctor, I am having some trouble understanding the methodology and the degree to which the results are significant. To what degree does this indicate an increased threat? If I am a diver with known cervical stenosis, how will this knowledge affect my dive planning?

Ditto to this... my husband and I are new divers. He has spinal stenosis and degenerative disk disease with most of the problems around the L4 and L5 region.

Does this mean that we should plan our dives to be extra conservative to avoid DCS (moreso than usual)... or is it just a coincidence that these divers ended up having spinal stenosis?

 

[DocVikingo]

He has spinal stenosis and degenerative disk disease with most of the problems around the L4 and L5 region. Does this mean that we should plan our dives to be extra conservative to avoid DCS (moreso than usual)...?

Hi Button,

This study addresses only cervical & thoracic vertebral disk degeneration and possible associated spinal stenosis with increased risk of spinal cord DCI. It makes no mention of the lumbar area, which, considering the selection of subjects, may be a good thing in your husband’s situation.

Also, the graphic I posted for you shows that the spinal cord does not extend down into the L4-L5 area. Here’s another graphic if the 1^st was confusing --> http://classconnection.s3.amazonaws...3/jpg/spinal_cord_gross_view1318009524851.jpg. As such, this would seem to greatly reduce the worry of spinal cord compression within the lumbar spine, no?

Regards,

DocVikingo

This is educational only and does not constitute or imply a doctor-patient relationship. It is not medical advice to you or any other individual and should not be construed as such.

 

[button]

Ahh sorry! My reading comprehension today is not so great. I get it now.

Thanks for the clarification!

 

[kelemvor]

[-]Is the whole study available anywhere?[/-] (Found it on nature.com) I've got a cervical stenosis due to some kind of genetic defect. Had to have a discectomy and fusion (c2-c6) and I'm told I've got another fusion of c6-7 in my future. I'd like to bring this in to my doc to see what he thinks about it.

Or does the removal of the disc mean it's no longer a concern for me?

https://secure.flickr.com/photos/14865808@N00/4362475659/
https://secure.flickr.com/photos/14865808@N00/4363217704/

 

[DocVikingo]

Have you seen more than the abstract? Not being a doctor, I am having some trouble understanding the methodology and the degree to which the results are significant. To what degree does this indicate an increased threat? If I am a diver with known cervical stenosis, how will this knowledge affect my dive planning?

Hey John,

No, to date I have only seen the abstract.

The degree to which the results are significant is that cervical & thoracic spinal canal narrowing was more common in divers who sustained spinal cord DCS than in controls, to wit: 79% vs 50%. This difference yields a probability of p=0.021, which is highly statistically significant. Also, a significant linear association between the extent of canal stenosis, multisegmental findings & the development of spinal cord DCS was reported.

As to how these retrospective findings on a relatively small number of rec divers might affect dive planning, I personally see no reason for undue alarm, but staying with conservative profiles through the traditional steps might be prudent.

Regards,

DocVikingo

This is educational only and does not constitute or imply a doctor-patient relationship. It is not medical advice to you or any other individual and should not be construed as such.

 

[Dsix36]

[-]Is the whole study available anywhere?[/-] (Found it on nature.com) I've got a cervical stenosis due to some kind of genetic defect. Had to have a discectomy and fusion (c2-c6) and I'm told I've got another fusion of c6-7 in my future. I'd like to bring this in to my doc to see what he thinks about it.

Or does the removal of the disc mean it's no longer a concern for me?



https://secure.flickr.com/photos/14865808@N00/4362475659/
https://secure.flickr.com/photos/14865808@N00/4363217704/

I went throiugh cervical discetomy with fusion a while back. My doctor gave me the ok to dive to 600' after the new bone grew in fully. he told me that there was now significantly less concern than when the damaged disc was still there.

This is just my story and is not medical advice for you to use for your own dive planning.