Recompression for Spinal Cord Decompression Sickness: Onset Time and Treatment Protocol

Lee, Seung Hyun; Ahn, Jin Young

Abstract

BACKGROUND
Symptoms of spinal cord decompression sickness (DCS) occur almost immediately after emerging from the water. It is recommended that recompression treatment be performed soon to decrease the bubble size and avoid further tissue injury. Unfortunately, there may be significant time delay from surfacing to recompression. The recompression therapy of which the hyperbaric treatment is effective is unclear. The purpose of this study was first to evaluate the effect of delayed hyperbaric treatment, initiated more than 30 hours after surfacing for DCS and second, to evaluate the different treatment protocols.
METHODS
Sixty-eight injured divers presenting symptoms of spinal cord DCS were retrospectively included from the Seoul Medical Center. Diving information, time interval between symptom onset, and hyperbaric treatment were studied. The initial severity of spinal cord DCS was rated with the Boussuges severity score and muscle power examination and the presence of sequelae was evaluated at two weeks. Initial recompression treatment at 2.8-4 ATA (atmospheres absolute) with 100% oxygen breathing or deeper recompression was conducted.
RESULTS
There were no significant differences between each group in age, diving experience, depth of dive, bottom time of dive, and Boussuges's score. With respect to treatment results, for the delayed treatment divers, good recovery was achieved in 47.1% of the divers. When treatment started early, good recovery was achieved in 58.8% of the divers. Hyperbaric treatment using the U.S. Navy Table 6a protocol trended toward a better clinical outcome, statistically significant (p=0.04) compared to the U.S. Navy Table 6.
CONCLUSIONS
The prognosis was as good as the early treatment when the recompression therapy was delayed in patients with spinal decompression sickness. Hyperbaric oxygen treatment was better in the U.S. Navy Table 6a than the U.S. Navy Table 6 in patients with spinal decompression sickness.