Cauda Equina Syndrome & diving

[gd_gonediving]

Dear Dr!
I find myself on this site 6 weeks after suffering a major disc herniation resulting in Cauda Equina Syndrome... a synopsis of events...


"A 32year old diving instructor suffered an accident (unrelated to diving) to his lower back, developed an L5/S1 disc lesion & left side sciatica and was in the process of referral to a spinal surgeon when he sneezed and developed acute spinal compression & Cauda Equina symptoms. Had midline decompression within 18 hours, recovery was complicated by a dural tear which had to be stitched some 12 days after original surgery.

He is left with the need for intermittent catheterization, bowel sensation that is slowly returning and saddle anaesthesia from mid gluteal area to half way down the upper legs (classic Cauada Equina Syndrome). Apart from this he has fairly normal muscle strength and walks normally. His question is whether he will be able to return to his previous occupation if his improvement does not get beyond the present level. His surgery was on the 5th of September so more improvement is still possible as we understand nerve growth can take up to 2 years."

Clearly i understand that whatever happens ill be looking at a good 6-12months before considering a return to diving, but it has already been indicated to me i wont be able to carry on instructing and probally no diving and simply im being told its because its too big a nerological event!. Are there any other instances of CES within divers you know about. Why can paraplegics and Quads still dive and im being told no?? there seems to be no info available on Mr. Google relating to this topic so some insight would be greatly apreciated!!!!
Thanks
Glen

 

[DocVikingo]

Hi Glen,

That's not happy news.

An answer to the question, "Why can paraplegics and quads still dive and I'm being told no?," could read as follows:

The majority of para- and quadriplegics already have sustained essentially permanent damage to the spinal cord with partial or complete paralysis of the involved limbs. Among those very, very few who dive, there appears little additional damage that can be done to the affected spinal cord area. Additionally, they typically are assisted in donning and doffing gear either sitting on edge of the deck or in the water, thereby minimizing stress on the vertebral column, and they dive very conservative profiles, thereby minimizing the possibility of spinal DCI. Moreover, the vast majority are not employed as dive instructors where they are responsible for the routine safety and welfare of scuba students, including performing rescues if necessary.

On the other hand, the dive instructor with a history of cauda equina syndrome secondary to disk herniation in the L5/S1 region with emergency midline decompression complicated by a dural tear and with a need for intermittent catheterization, incomplete bowel sensation, and saddle anaesthesia is in a rather different situation.

First, given midline decompression only about 5 weeks ago, and subsequent repair of a dural tear only about 2 weeks ago, it is far too soon to estimate the extent to which sensory functions may recover. Leaving aside issues of nerve regrowth, and this is a rather complicated matter, the acute effects of the herniation and surgical interventions haven't yet subsided. While recovery depends upon on a number of factors, and complete recovery is not assured, improvement certainly would be expected.

Second, even after functioning has reached final improvement, scuba still could result in additional damage to the cord level involved, either as a result of mechanical trauma or gas phase abnormalities.

It's simply too soon to be attempting to arrive at an answer about return to work as a instructor, or even returning to diving. It might be wisest and least anxiety provoking to allow healing to be much further underway before revisiting the return to employment issue. Imaging and functioning findings at say 6 months post-op should provide a much clearer picture.

Helpful?

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.

 

[gd_gonediving]

Hi there
Thanks for such a prompt reply. I today had replies from some of the Hyperbaric medics here in australasia and New Zealand. They have indicated much the same in respect that at the moment i have a lot of quality of life to look forward to and that if there were an incidence of DCI then it would be 'gunning'for my weak spot - the existing nerologic lesion - which clearly could send me backwards neurologically to the point of complete impairment.
I also appreciate, as instructors, we have a certain duty of care to uphold. Would an idiotic novice diver having a runaway ascent place me in more danger of DCI because of the exisiting legion - i guess if the answer is yes then i am not affording my students the upmost duty of care.
So for the time being a change of career is most likely. I thank you for your comments and would appreciate any links to websites you or any of the forum readers may deem i find informative.
Finally, in the future once final recovery has been established, what is the likelyhood of being able to return to recreational diving with heavily restricted depths and times - i.e. can i go bum around on top of a reef in 8m of water for half an hour?!?!
I miss my clown fish!
Thanks, Glen

 

[do it easy]

I dive with para and quad divers and we routinely go to 20'-30'. Dive time is limited by the fact they they tend to get cold faster, although I recently did a 60 minute dive with a para diver in 85f water temps.

In my unqualified opinion, it sounds like you won't have the temperature problems since you have "fairly normal muscle strength."

Good luck!