Questions: Dive-related risks for lumbar decompression surgical procedures

[-JD-]

@Duke Dive Medicine Thank you for the reassurance on DCS! That leaves me to focus on the best mechanical/functional results ...

@Akimbo , @tursiops , @lowflyer , @NelleG , @Joris Vd , @ofg-1 - Thank you for sharing your your experiences and suggestions. I feel for your individual situations and I appreciate the support immensely.

While no super-man by any stretch, my identity is tied to self-reliance and "doing" - often "my-way" because I'm stubborn, even if it is harder. This has been a humbling experience, but I am still hopeful that with some luck and rehab work, my diving may not have to change much (twinsets are going anyway, too heavy/unwieldy unmounted - I've been planning BM, independent, doubles anyway to get away from moving twins.), but If I need to modify, I will.

For those that have urged avoiding surgery, your points are well taken. One concern with my situation was the possibility of extensive permanent nerve damage from the impingement if it remains for long-enough. I'm looking for another assessment now to see if urgency remains with my still-limited improvement. Ironically, I'm going to an orthopedic spine surgeon to, in part, ask him if non-surgical approaches are safe to try and likely to produce a long-term stable "fix" that can take me from 50-60% capability to something very close to normal.

I'm looking forward to getting a straightforward assessment of exactly what is going on in my back from a specialist. The remainder of today will be more research and honing my questions and talking-points for tomorrow morning.

Thanks all!!!!

 

[tursiops]

@Duke Dive Medicine Thank you for the reassurance on DCS! That leaves me to focus on the best mechanical/functional results ...

@Akimbo , @tursiops , @lowflyer , @NelleG , @Joris Vd , @ofg-1 - Thank you for sharing your your experiences and suggestions. I feel for your individual situations and I appreciate the support immensely.

While no super-man by any stretch, my identity is tied to self-reliance and "doing" - often "my-way" because I'm stubborn, even if it is harder. This has been a humbling experience, but I am still hopeful that with some luck and rehab work, my diving may not have to change much (twinsets are going anyway, too heavy/unwieldy unmounted - I've been planning BM, independent, doubles anyway to get away from moving twins.), but If I need to modify, I will.

For those that have urged avoiding surgery, your points are well taken. One concern with my situation was the possibility of extensive permanent nerve damage from the impingement if it remains for long-enough. I'm looking for another assessment now to see if urgency remains with my still-limited improvement. Ironically, I'm going to an orthopedic spine surgeon to, in part, ask him if non-surgical approaches are safe to try and likely to produce a long-term stable "fix" that can take me from 50-60% capability to something very close to normal.

I'm looking forward to getting a straightforward assessment of exactly what is going on in my back from a specialist. The remainder of today will be more research and honing my questions and talking-points for tomorrow morning.

Thanks all!!!!

Good plan. I delayed over a year while trying all of the recommended alternatives to surgery, and then almost had to talk my surgeon into doing the surgery because of my age (he said he was concerned about my response to general anesthesia, but did not say -- but clearly thought -- why would I take a chance with surgery when I didn't have THAT many years left....).
Talk to more than one surgeon.....and don't both asking about the upside of the surgery, but focus on their views of the down sides.

 

[tridacna]

Nice to hear that it's not just me. Thanks for the thread. I'm in the midst of a Sciatica nightmare too. Great advice from all.

 

[-JD-]

Nice to hear that it's not just me. Thanks for the thread. I'm in the midst of a Sciatica nightmare too. Great advice from all.

Sorry to hear that!!

Maybe we should look into a group-buy deal?

 

[tridacna]

Sorry to hear that!!

Maybe we should look into a group-buy deal?

Don't even start. My insurance company wanted 3 months of PT before even authorizing an MRI.

 

[rjack321]

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 ... "

I have had three herniations (and three microdiscectomy surgeries) but no foraminal narrowing so I don't know how relevant my spine is to yours.

One was at C5-6. This was a completely incapacitating injury probably not unlike yours. It was way past any attempt at resolution via injections etc, so I had microdiscectomy surgery fairly quickly and was out of diving for ~7 months. This old injury does lead to increased sensitivity to DCS. It's like my "trick knee" I absolutely know when I have not done enough deco as my radiating arm pain symptoms return in a milder form. I have concluded this is due to poorly vascularized scar tissue retaining bubbles along my nerve root. I dive more conservatively with longer shallow stops than models call for and rarely have issues. This was 18 years ago now. I consider my C spine at about 90% of its previous status but I'm all around older so I'll take it.

The other two herniations were at L4-5. Basically I herniated it, then about 9 months after that microdiscectomy I herniated it again and the second disk chip was removed all over again. Recovery time was much shorter (but the herniations were also less severe than the previous one at C5-6) and about 3 or 4 months. I have no residual effects from these 2 surgeries other than being more cautious than ever with weight and stooping. This was about 8 years ago and my lumbar spine is 95%+ of "normal"

Personally I am not afraid of surgery. I had a second opinion with a physiatrist between lumbar surgery 1 and lumbar surgery 2 and he basically told me that he would have me hobbling around for a year before he'd recommend surgery. I refused to put my life on hold for years. My surgeon did the microdiscectomy revision about a 2 or 3 weeks after that 2nd opinion and I was fully functional within about 2 months and single tank diving again at 3 months.

Since my disks are terrible I refuse to see a chiropractor - I'd be at high risk of repeat herniations from their manipulations.

 

[tursiops]

Since my disks are terrible I refuse to see a chiropractor - I'd be at high risk of repeat herniations from their manipulations.

I've only been to a chiropractor twice; both times were a big mistake. Once was enough to teach me a lesson. I have no idea why I tried again decades later. I guess I forgot the lesson.

 

[James79]

I'm a little over 8 months past my L5-S1 fusion. History of back pain for years, then a major blowout that sent me to the ER 2 years or so ago... Disc was pinching the nerve leading to foot and leg pain. To say I was non functional at that point is an understatement. Due to my job, they pushed all the non invasive options for a very long time... Now my main complaint is not having gotten surgery sooner.

One concern with my situation was the possibility of extensive permanent nerve damage from the impingement if it remains for long-enough

In my case, I still have a change in sensation in my right foot (sometimes numb, sometimes hyper sensitive) that will remain for the rest of my life. Permanent damage from the long term impingement. On the bright side, my constant low back pain and the shooting pains that used to run up my leg are all but gone.
As others have said, everyone is different and every situation is different. Best advice I got from a back surgeon was wait until the day to day pain was bad enough that I couldn't talk myself out of surgery any more.... For 5 years I wasn't there. I was there after the major blowout, but was forced to wait then, lol.
My end result is pretty good... doesn't really effect my diving, I can carry a pair of tanks at a time (I'm just more cautious of my body mechanics while I do).

my identity is tied to self-reliance and "doing"

Me as well. Surgery recovery is hard... this makes it harder. Make sure you have someone you can trust to talk to.... someone who can remind you that this is temporary.
Best wishes,

James

 

[dmaziuk]

I have had three herniations (and three microdiscectomy surgeries) but no foraminal narrowing so I don't know how relevant my spine is to yours.

Spine surgeon I saw back when said that with some people "I see the size of the hole and I'm amazed this person is not in pain all the time". He too was advocating non-surgical treatments for as long as possible, and I've been spending 5 hours/wk in the pool (more like 3 now thanks to covid) and been very careful with what I lift, how, and how often, for close to a decade now.

 

[-JD-]

Update:

I saw my spine surgeon yesterday (An aside: 3 minutes in he had to step out to take an emergency call from the ER ... "It surprising how many idiots get drunk, fall down steps, and break their necks" ... he had four (yes that is 4) stacked up from the previous night. With a bit of guilt, I feel somewhat assured that my guy seems to be the go-to surgeon for dealing with quadriplegia-risk trauma.)

We went over my my anatomy, reviewing the MRI imagery. The arthritic stenosis is typical, minimal, commensurate with my 53 years and not really a fundament issue. We looked at the disk herniation (OMFG!!!!!!), it seemed to completely fill the foramen (nerve passageway) - no wonder my nerves are freaking out! It is an extrusion, not a "bulge".

Surgically, his approach would be a Laparoscopic/Endoscopic technique: A microdiscectomy removing the extruded disk material. And a foraminotomy to shave a limited amount of the bone to enlarge the opening for the nerves. (His previous notes about a facetectomy are more about procedure coding than anything) He is absolutely in agreement about not causing any structural disruption that isn't absolutely necessary. We also discussed minimization of vascular damage for managing DCS risk.

But, we are not going to surgery, yet. He wants to see if the non-surgical path can give me the necessary function in a reasonable time frame. He's prescribed PT (which I'd been hoping for earlier, and my GP suggested I Google "airplane seat exercises" ) and suggested that I hold off on additional injections as I'll probably only be able to get one more any time soon. Evidently re-absorption of the extruded material is possible, at least to some degree.

Today, I get to try to figure out which PT facility is the best and has availability. Turns out there are ten (yep 10) in about a 1.5 mi radius from home, and I am in the suburbs ...

Again, thanks all for everybody's support and sharing.