SPINAL-CORD DECOMPRESSION-SICKNESS IN SPORT DIVING

Objective.-To summarize 16 years' experience in the diagnosis and trea tment of spinal cord decompression sickness in Israel. Design.-The sur vey 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 div ers diagnosed as having spinal cord decompression sickness. Interventi ons.-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 b y 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 wer e performed within the decompression limits of the US Navy standard de compression tables. Risk factors were fatigue, circumstances suggestin g 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. Sp inal symptoms appeared immediately on surfacing in six of the eight pa tients who continued to have multiple neurological sequelae. Conclusio ns.-United States Navy air decompression tables appear not to be compl etely safe for sport divers. Even mild spinal symptoms identified on s urfacing should be treated vigorously. High-pressure oxygen-helium the rapy seems to be a promising alternative in cases of severe spinal cor d decompression sickness.