title: Relation between cervical and thoracic spinal canal stenosis and the development of spinal cord decompression sickness in recreational scuba divers.
abstract: METHODS
  Retrospective case-control study.
  
  
  OBJECTIVE
  The intent of this study was to investigate the relationships between vertebral degenerative changes resulting in spinal canal stenosis, spinal cord lesions and the development of spinal cord decompression sickness (DCS) in scuba divers.
  
  
  METHODS
  Referral hyperbaric facility, Toulon, France.
  
  
  METHODS
  We examined 33 injured divers less than 50 years old by cervical and thoracic MRI and compared them with 34 matched control divers. The number of intervertebral disk abnormalities and the degree of canal compression were analyzed on T2-weighted sagittal images using a validated grading system developed recently. The presence and the distribution of hyperintense cord lesions in relation with the accident and the recovery status at 6 months were also assessed.
  
  
  RESULTS
  Canal spinal narrowing was more common in injured divers than in controls (79% vs. 50%, OR=3.7 [95% CI, 1.3-10.8], P=0.021). We found a significant linear association between the extent of canal stenosis, multisegmental findings and the development of spinal cord decompression sickness. MRI intramedullary lesions were significantly more frequent in divers with incomplete recovery (OR=16 [95% CI, 2.6-99], P=0.0014), but statistical analysis failed to demonstrate a significant relationship between canal compression, signal cord abnormalities and a negative clinical outcome.
  
  
  CONCLUSIONS
  These results suggest that divers with cervical and thoracic spinal canal stenosis, mainly due to disk degeneration, are at increased risk for the occurrence of spinal cord decompression sickness.
authors.affiliation: Diving and Hyperbaric Medicine Department, Sainte Anne's Military Hospital, Toulon Cedex 9, France.
authors.forename: E
authors.initials: E
authors.lastname: Gempp
authors.affiliation: Diving and Hyperbaric Medicine Department, Sainte Anne's Military Hospital, Toulon Cedex 9, France.
authors.forename: P
authors.initials: P
authors.lastname: Louge
authors.affiliation: Radiology and Diagnostic Imaging Department, Sainte Anne's Military Hospital, Toulon Cedex 9, France.
authors.forename: T
authors.initials: T
authors.lastname: Lafolie
authors.affiliation: Diving and Hyperbaric Medicine Department, Sainte Anne's Military Hospital, Toulon Cedex 9, France.
authors.forename: S
authors.initials: S
authors.lastname: Demaistre
authors.affiliation: Diving and Hyperbaric Medicine Department, Sainte Anne's Military Hospital, Toulon Cedex 9, France.
authors.forename: M
authors.initials: M
authors.lastname: Hugon
authors.affiliation: ERRSO, Institute of Biomedical Research of the French Armed Forces Health Service, Toulon Cedex 9, France.
authors.forename: J E
authors.initials: JE
authors.lastname: Blatteau
mesh_terms: D000328:Adult; D016022:Case-Control Studies; D002574:Cervical Vertebrae / Q000473:pathology*; D003251:Constriction, Pathologic; D003665:Decompression Sickness / Q000473:pathology*; D019299:Decompression, Surgical / Q000379:methods; D004242:Diving / Q000009:adverse effects*; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D012189:Retrospective Studies; D013115:Spinal Canal / Q000473:pathology*; D013119:Spinal Cord Injuries / Q000473:pathology; D013130:Spinal Stenosis / Q000473:pathology*; D013904:Thoracic Vertebrae / Q000473:pathology*; D055815:Young Adult