Comprehensive information about diving and undersea medicine for the non-medical diver, the non-diving physician and the specialist.
Diving With Unoperated Disc Disease
Diving with un-operated herniated disc disease is thought by some authorities to constitute a contra-indication to scuba diving. However, post surgical and healed vertebral fusions generally are thought not to impose any restrictions on diving. In addition, there is the theoretical caveat that there is an increased risk of bubble formation in regions of bone where there has been some disruption of blood supply - leaving an increased or decreased vascularity. There have been no studies to prove or disprove these cautionaries, however.
Cervical disc problems causing radicular neuropathy should not dive until this has been surgically repaired. It would be our feeling that if you dive, you should discuss this with your surgeon in terms of weight-bearing, climbing and the hyperextended neck position that is required with scuba diving.
You would be wise to have a neurological examination carefully recorded and with you on your dives for comparison reference in case of a decompression accident.
Lumbar herniated discs without protrusion can and do dive - however, there is a definite risk of acute herniation with the lifting activity and strain of getting back into the boat. Acute herniation can mimic a decompression accident.
Return to Diving Post-surgical
There are no set guidelines that govern the return to diving after disc surgery. This will depend to a great extent on the type of surgery, presence or absence of complications, whether or not a fusion has been done and if there have been any complicating factors, such as a wound infection or residual symptoms.
Generally, a person may return to diving in three months with the OK of the operating surgeon.
There is an absolute contraindication to diving after disc surgery that has failed and results in spinal stenosis. If there is major residua or deficit after the surgery--one probably should not dive. There is a relative contra-indication to diving after having a herniated disc repaired below L1-2 and a repaired cervical disc from the anterior approach--both should wait at least 3 months and then dive only if there are no residua.
There are those who theorize that the possibility of Neurological DCS would be more likely with bubble formation at the site of the disruption of the vasculature in the operative area. No man studies bear this out. Some feel that back surgery and previous DCS of the spine are possibly predisposing factors in the formation of spinal DCS. (Caroline Fife, MD).
Fred Bove, MD ("Diving Medicine"--Bove and Davis) feels that there is clear evidence that minimizing bubble formation is essential for safe diving and to avoid long-term damage to the central nervous system. This goal can be achieved by conservative diving that reduces the total exposure to nitrogen under pressure.
Retrospective studies of diving accidents have indicated that the threshold depth is arbitrarily 86 feet. If you have had successful surgery without residua (neurological findings) you can dive (sport, not commercial).
People with compression fractures with nerve root or spinal deficit residua, even if episodic, should not dive until the problem is repaired by spinal fixation. Symptoms of numbness and pain are mimicked by decompression sickness and pose problems in differentiation after a dive. The chances of even more scar tissue developing postoperatively are great. Weight bearing and donning gear on the surface can be real problems to the affected diver, even though it is stated that once in the water they are more comfortable due to the loss of gravity effects.
DAN feels that diving should be postponed until the back is surgically stabilized. With significant symptoms, it wouldn't take much to become paraplegic--and then the diver would be in a jam. Ironically, if the diver were paraplegic and stable--then we could make some arrangement for him to dive --but that's certainly not what we want!
A diver has to carry his equipment on land (boat) and be able to perform hard physical work on occasions. Weight-bearing with grade 3 spondylolisthesis can certainly lead to nerve root compression, resulting in severe pain, paralysis and loss of function. In addition to causing its own difficulties, this can mask neurological symptoms caused by decompression illness. Until surgically repaired, significant spondylolisthesis would be disqualifying; a three month post operative period should be allowed and no diving at all if there are significant residuals.