vacuum cleft

[Calinectes]

I recently suffered a nerve compression incident after a 3 dive day. Lost all feeling in my lower leg from the knee down for over an hour. It completely resolved itself as soon as the boat got back to shore and I stepped down in the sand. I have a history of lower back pain and degenerative disk disease (yes I'm 47 yo). I went to the doctor when I got home from the trip and she ordered an Xray and MRI. The MRI is being denied by my insurance company at the moment... something about documenting 6 weeks of conservative treatment first.

The radiology report had an interesting finding and I wondered if it has any consequence when under hyperbaric conditions. There are progressive degenerative disk changes at L4-5 which include some uniform loss in disc space, progressive marginal spurring in addition to a vacuum cleft. There are premature degenerative disc changes at L1-2 and L5-S1.

A nerve root compression at these discs would certainly correlate with where the numbness was.

I would love to hear thoughts on this.......

 

[Solly]

I had a similar experience few months ago with no history of disk issues... Hyperbaric doctor said my symptoms are inconclusive and it can be or not DCS
when doing an MRI it showed disk degeneration that woul cause numbness in my leg as my symptoms were.... I was asked to lose weight, try to work on strengthing my back muscles and take extra car while diving when it omes to carrying equipments and tanks....

 

[Dr Deco]

Hi Calcinetes:

Not my field. I will let the medical commentators address this one.

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A ScubaBoard Staff Message...

Thread relocated from Ask Dr Deco to Diving Medicine.

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[Pao]

Where exactly was the numbness? Lateral, on the outside? Lower leg only? Thigh? Any accompanying weakness?

 

[Duke Dive Medicine]

A reasonably good explanation here:

The Intravertebral Vacuum Cleft Sign1

This is best addressed by a neurosurgeon or orthopedist specializing in spinal issues (depends on who does what in your area).

Best regards,
DDM

 

[DandyDon]

The MRI is being denied by my insurance company at the moment

One of the reasons for dive insurance. Do you not have either DAN or Dive Assure...?

 

[Calinectes]

Thanks for the responses so far...... my whole foot and lower leg went numb.... started as pins and needles (which I get when I sit cross legged for too long). I straightened the leg out, tried to stand on it for a while on a moving boat in choppy water etc... but lost all feeling below the knee. Still had muscle control, no discoloration or swelling, just no proprioreception.... Kind of like a stump down there. I had no other symptoms either. It completely and spontaneously resolved itself as soon as I was back on shore with no loss of function. Dove again 2 days latter without any issues. Did not call DAN (yes I carry insurance).... saw my regular doctor the following week when I got home from vacation.

My question for you guys is more of an analytic excercise.. can the presence of a vacuum cleft in a disc cause a nerve compression when under hyperbaric conditions? Since it's a gas filled space in a minimally vascularized area is it susceptible to accumulation of excess nitrogen during a dive?

I will eventually get an MRI to go along with the Xray... especially because my back is getting worse with age..

I love the insights on this board...

 

[Pao]

Seems like nerve compression but much lower down-not at the nerve root level. It may just be due to sitting in the wrong position for too long. Vacuum disk phenomenon is usually just part of the degenerative process. It may however have other causes depending on the associated findings. Its formation is similar to what happens when you crack a joint by pulling on it. The negative pressure produces a vacuum leading to accumulation of gas (mostly nitrogen). I do not know if it can lead to bends but theoretically any scar tissue (in this case produced by the actual degenerative changes) can make the area more susceptible to nitrogen accumulation.

 

[DandyDon]

Did not call DAN (yes I carry insurance).... saw my regular doctor the following week when I got home from vacation.

Ok, well - glad you have DAN membership & insurance. I'm curious why you haven't used it? You got some of the best dive doctors available there and at Duke U. I hope they will cover the MRI too, but you'd have to ask.

 

[DocVikingo]

This is best addressed by a neurosurgeon or orthopedist specializing in spinal issues (depends on who does what in your area).Best regards,DDM

What DDM said, and preferably one with some knowledge of diving medicine.

Regards,

DocVikingo