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Questions: Dive-related risks for lumbar decompression surgical procedures

Discussion in 'Diving Medicine Q&A' started by -JD-, Mar 9, 2021.

  1. -JD-

    -JD- Eclecticist ScubaBoard Supporter

    # of Dives: 50 - 99
    Location: Greater Philadelphia, PA
    1,059
    734
    Howdy fellow SBers.

    I'm soliciting advice and questions for my surgeon for an upcoming evaluation/planning appointment in 2 days.

    Summary:
    I'm dealing with L3 L4 disk herniations and (some ?) stenosis resulting in radiculopathy (pinched nerves - Sciatica) affecting my right side from the top of the pelvis to my foot.. After total incapacitation for 8-days, two rounds of Foraminal (spine) Injections, I can sit, stand, hobble/walk a limited amount, with increasing discomfort with time and without any narcotics..
    I'm seeing my ortho-surgeon (spine specialist) to discuss surgical appropriateness, options, prognosis, etc.
    From his initial evaluation notes: "... I would like him to get an emergent L3-L4 right-sided block and see if that helps him it would be an option to try to get him better if that does not help he is going to need surgery which would include a right-sided L3-L4 facetectomy foraminal decompression. ... but I really think in the long run he is going to need surgery he has a large herniation ... "

    Goal:
    Frankly, I'm looking for full restoration of function with the expectation that I will need to exercise ongoing, reasonable caution to prevent re-injury.

    My top priorities are:
    1) Full restoration of life function - including diving to Tech-lite levels (AN/DP/Heliotrox). - I don't expect to be carrying twin water heaters and 6 stage bottles)
    2) Minimization of the potential for recurrence and structural weakening.
    ...
    ?) Reducing surgical pain, invasiveness, recovery time/effort would be great, but only secondary to function and long-term stability.


    Questions:
    Understanding that in general surgical scarring may present DCS risk ...

    What specific risks are caused for diving by the following procedures:
    - Microdiscectomy
    - Foraminotomy
    - Facetectomy
    - Disk Replacement
    - Open vs. Laparoscopic approaches for the above


    What specific questions should I be asking my surgeon about the impact on my diving?

    I'm open to relevant anecdotal experiences in addition to expert opinions on the different procedures.


    Very long-winded background to hopefully fully frame my situation should you are bored:
    I was undergoing Chiropractic treatments starting in January for misalignment in my back stemming from some ill-executed maneuvering of some heavy items in December. Starting in January, around the beginning of my treatment, I had some annoying Sciatica at my back across the pelvis and over my hip that made me hobble a bit and maade standing upright uncomfortable. My Chiro and I discussed getting the sciatica evaluated and I had an appt with my primary for a few weeks out (guy is busy). Until my last chiropractic appointment, the treatments did not seem to affect the sciatica for better or worse. At my last chiro appointment (Feb 4, in for a final "tweak"), I was almost unable to walk after the appointment and had to stop and sit several times on the way out.
    Fortunately, I was able to get a cancellation slot with my primary that evening. At that point the sciatica had increased notably, now affecting down to my right thigh and I was moving around on crutches. He evaluated me, pain level, range of motion, etc. Said I was going to probably need an MRI, but had to get X-Rays first.
    I got the X-Rays the next morning, driving myself and in and out on crutches with serious, but manageable pain. Mid day I made a short drive (maybe 5-6mi round trip) to pick up my wife's car from the mechanic's and by the time I (barely) returned home, the pain had exploded radiating down the leg to my foot, leaving me in neurological overload and unable to move for a half hour.
    For the next 8 days, I was unable to be in any position other than carefully on my back or left side. No solid food. Pain was slightly moderated by Percocet.
    X-Ray-results were not informative and the MRI was ordered. After the MRI results came in, my primary referred me to the ortho surgeon for evaluation.
    The ortho surgeon, evaluating my incapacity, pain level, and MRI sent me IMMEDIATELY across the hall to the outpatient surgery center for foraminal injections and said "See me when you need surgery."
    The first round of foraminal injections gave me enough relief to be able to sit-up for short periods and resume eating within a couple days; eventually being able to move around reasonably with crutches for limited distances
    The second round or foraminal injections 2 weeks later, allowed me to come off the narcotics and I can now sit-upright, stand, walk/hobble for a limited time after 1-1/2 weeks.
    At this point I would estimate I am between 50-60% functional. My ability to work is reduced and unsustainable for the long term, but I have been working around it as best that I can for now. Obviously, any diving would be "with disability" at best at this point.

    FWIW, I've read through the following threads:
    Neck Pain keeping me from Diving
    Post surgery diving
    Herniated Disc
    Got vertebral degenerative changes? Your risk for spinal cord DCS may be elevated.+
    Back or Spinal Surgery and diving
    Need some advice, herniated disk at C8
     
  2. Akimbo

    Akimbo Just a diver Staff Member ScubaBoard Supporter

    10,879
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    I imagine that you have seen many of these already but there are quite a few YouTube videos. My lovely bride is investigating a cervical fusion (neck). There is tons of info that isn't directly diving related, but is a good source for things to consider — from questions for surgeons, pre and post op prep, and physical therapy.

    One of my takeaways from investigating cervical fusion is the level of research you are doing often makes a huge difference is achieving the best outcome. Good on ya mate and best of luck on this journey.
     
    -JD- likes this.
  3. tursiops

    tursiops Marine Scientist and Master Instructor ScubaBoard Supporter

    # of Dives: 2,500 - 4,999
    Location: U.S. East Coast
    11,617
    9,527
    Good luck, bud. My story is similar, although not quite as bad. left side, L3-L4 and L4-L5, sciatica stopped at my knee. Stenosis.
    Chronology:
    • April-May 2028. back spasm, PCP prescribed muscle relaxant and PT, did four session PT. Ok afterwards.
    • June 2019-Jan 2020: following annual physical and reporting continued, intermitten lower back pain, began PT 1-3x/wk. Pain began to travel down my leg. Activity ws inhibited. chiropractor visit a failure; never again.
    • Feb 2020: Consultation with spine specialist, began epidural injections.
    • Mar-Jul 2020: 5 total epidurals, minor and short-term relief. Referral to orthopedic surgeon and consultation with him.
    • Aug 2020: Decision to do the laminectomy (microdiscectomy) on L3-L4 and L4-L5. Surgery Aug 24. By the weekend (5 days post-op) I was walking a mile a day, sore and tired, but no pain.
    • Sep 2020: Walking 2 mile per day. Restarted PT.
    • Oct-Nov 2020: Walking 1-5 miles per day every day or two; Nov 11 release from surgeon to full activity.
    • Dec 2020: Ended PT. No pain doing anything. Exercising at home daily.
    It all sounds like good news except: the surgeon says there is a greater than 10% chance (due to my age) of another disk -- or the same ones -- popping within 6 months. I'm at 7 months now.....

    My conclusions? You are not me, your surgeon is not my surgeon, your risk/reward tolerance is different.
    Would I do it again? Yes, definitely, I went from my life being inhibited to full activity (although I ain't ever wearing doubles again).
    On the other hand, my father had the same issues many years ago and ended up -- after surgery -- in a wheelchair. So, success doesn't run in the family.
     
    -JD- likes this.
  4. Duke Dive Medicine

    Duke Dive Medicine Medical Moderator Staff Member

    2,817
    2,586
    Hi @-JD- ,

    I'm sorry to hear that you've gone through that. I was cringing just reading your description of the pain.

    Re diving, the operative word above is *may* and it's a big maybe. In general those surgeries don't negatively affect the blood supply to the spinal cord or nerve itself unless something goes wrong. Of greater concern would be your ability to bear weight and handle the increased load of diving equipment on your back. That's where I'd focus my questions if I were you.

    Best regards,
    DDM
     
    Lostdiver71 and -JD- like this.
  5. Marie13

    Marie13 Great Lakes Mermaid ScubaBoard Supporter

    # of Dives: 200 - 499
    Location: Great Lakes
    8,841
    7,432
    @-JD-

    Sent you a PM.
     
    -JD- likes this.
  6. Akimbo

    Akimbo Just a diver Staff Member ScubaBoard Supporter

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    Good points: Here are ideas you may be able to incorporate that I have learned while working with disabled diving veterans through commercial diving. I think it is fair to say that boat diving is generally a better option for divers with back issues.
    1. Sell your tanks and lead. Only dive off charters that provides them. You don't need to haul that weight between your diving locker, fill stations, or boats.
    2. Use weight pockets for lead, on a belt and/or on your harness, to limit having to transport more weight than necessary. Avoid weight systems that don't accommodate hard or soft weights. You will have to use what the boat has.
    3. Find charters that are willing to let you don and doff your tank in the water. Explaining that you had back surgery often greases the ways.
    4. Bring a line with a good snap hook to tether your tank in the water. I like to use 1/2" to 3/4" double-braid line because it is very hand-friendly for me and the crew. Double braid isn't stiff so stuffing it in a dive bag is easier. I find that 30' is about right. I use mine all the time when diving off inflatables.
    5. Make sure you have a good, preferably metal, D-ring at a convenient spot on your harness to a attach the tether.
    6. Put at least some of your lead on a belt so the crew has less weight to struggle with. A little weight low on your body also makes donning and doffing tanks in the water easier.
    7. I find that a snorkel is more comfortable when donning and doffing gear on the surface. YMMV.
    8. Use a freediving Marseille-style rubber belt because they can stay-put very low on your pelvis. That will keep the weight you do carry up and down the ladder off your spine.
    9. Consider using an old school style plastic or very light metal backplate like the Freedom Plate. I find that setting it up so you can pull the shoulder straps tight by tightening the belly band is easier when donning rigs in the water.
    10. You will probably want to set your gear up yourself, before filling lead pockets, so a minimal weight backplate will help with that in addition to transport.
    11. You probably already minimize baggage weight for dive travel. Bring that mindset into local diving too.
    12. Get smaller dive bags and maybe a lightweight folding cart or dolly. Try to limit the weight in each bag and the distance you have to lug them.
    13. Think about doing some freediving after surgery instead of going straight into Scuba. It is great whole-body physical conditioning, when you are ready, and will ease you into back into the game. You may also find ways to modify your gear and techniques before taking on the added burden of Scuba.
    14. Sidemount may be something to look into but it won't keep nearly as much weight off your spine as donning and doffing a back-mount rig in the water. It depends on how extreme you want to take the concept of keeping strain off your back.
    15. Think about making your fins easier to don and doff. Your back will be a little less flexible and adding strain to other joints will hasten their deterioration. Spring and bungee straps are recommended even with a perfect 18 year old back.
    16. Look at each piece of gear for places to shave weight that you don't need to transport. There may be better options than a BFK or cannister light for example. A metal SPG and an AI computer may not be worth the extra weight. Even if you're not carrying it up and down the ladder, you still have to get it between home and the boat.
     
    Jayfarmlaw and -JD- like this.
  7. lowflyer

    lowflyer Divemaster ScubaBoard Supporter

    # of Dives: I just don't log dives
    Location: SW
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    My experience doesn't predict your future experience. Just an example of a spinal fusion not meaning the end of diving.

    I've had both a cervical and lumbar spinal fusion. Neither impacted my diving itself. However, riding the dive boat to dive sites nearly did me in when going too fast through rough water with the bow slapping down hard on the water. Sit as far aft as possible.

    I hope things work out for you.
     
  8. NelleG

    NelleG Contributor

    # of Dives: 100 - 199
    Location: Sunapee, NH
    75
    72
    I am 6 years post lami, decompression, and L4-L5 fusion. About the only thing I don’t do is climb up the ladder with my gear on. I am very careful of how I move, no twisting and so forth. Always working on my core strength just to try to stay ahead of the game.
     
    -JD- likes this.
  9. Joris Vd

    Joris Vd Contributor

    # of Dives: 200 - 499
    Location: Belgium
    180
    127

    I have three herniated discs l3-l4 l4-l5 l5-s1 and severe wear on the l4-l5 .
    If I sit on a toilet for longer than 5 minutes I cannot feel my feet anymore.
    Fun fact: my girlfriend had to tie my shoelaces for a year or so. She would also make a double knot so there was no risk of my shoe untying while I was at work....

    First i'd like to stress this is my opinion, not medical advice.
    My Neurosurgeon told me he didn't want to fixate any of my discs as this will cause herniations above the fixed area in the future (I'm only 29) , due to the age to him it was not an option. It's not the prettiest solution, but what works for me is getting cortisone and painkiller shots in the facets every 3-6 months. This makes the pain bearable and makes me function somewhat normally. For diving, I had to tailor my diving to my back. I don't do long walks to the water anymore, preferrably boat dives

    . I still wear a twin set from time to time, but make sure it's not one of these short ones that pushes in my lower back.
    One thing that really helped me is putting ALL of the weight either on my backplate or on my hips. Nothing that pushes on the spine or lower back in any way, shape or form.

    Sidemount has been a nice relief for me as well. I've had to adjust the harness completely though because as soon as I get any pressure on the spine itself from the weights, my back starts hurting. Although I have to say, if I can't put on the tanks in the water itself, it's actually alot more compromising for the back and I will rather wear a tank then.

    One thing is for sure: if you get one of your discs fixated it's something that will affect you in the future. Spines are not really made to be fixated. I would suggest before you consider this operation, to atleast get a second opinion from a second neurosurgeon. I would also suggest going to visit a neorosurgeon not an orthopedic surgeon.

    Figuratively speaking, a neurosurgeon operates with a microscope, and orthopedic surgeon with a jackhammer.

    below you can see a photo of my sidemount harness and how I configured it so it doesn't put any weight on the lower back.
    126329326_885090638966142_9159563074749259794_n.jpg

    Yes yes I know, I don't have a crotch strap on my sidemount harness, but since I have most of the weight on the hips and don't scooter it works well for me.

    One thing I have noticed over the three years I've been getting these shots is the fact that usually the first medrol shot takes care of the bulk of the pain (70%) and the other ones don't seem to do much. This could also be due to the fact that in my case the disk are pressing in the middle. Normally a disc will be pinched on one side of the spine. I can get away with putting some weight in the top two back pockets between the shoulder blades, lower means trouble.

    As said above though the main dangers are not in the diving but the hauling of gear.

    It's the things you don't think about:
    So yeah, just start behaving like a grandpa, no more twisting and turning.
    No more heavy twinsets.
    Also try to get someone to do your fills, I don't know if you have a very understanding partner who is willing to haul your tanks? I feel like most of the back pain and issues I get are from carrying the tank from and to a filling station.
    When hauling something up a step, putting it in a trunk, laying it down etc, there are alot of tiny adjustments that can mess up your back.
    Also be very careful on water entry and exit. Slipping with a tank on is my worst nightmare. I've had it recently and couldn't walk for a week.
     
    -JD- likes this.
  10. ofg-1

    ofg-1 Course Director

    462
    1,121
    OK, my opinion from a old man. Try anything else before surgery. Try acupuncture, limited inversion, witch doctor, consult a physical therapist. I am not a huge fan of chiropractic, for my lumber issues, they actually made it worse.

    Yes I know you have a mechanical defect. I also have never known anyone that had one lumbar surgery. They seem to have two or three. Acupuncture helped me as much as anything else. Some days, if I bend over to tie my shoes, I stay bent over. For hours.

    Best of luck.
     
    -JD- likes this.

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