Spinal cord compression, cervical stabilization

Dear CCF Neurosurgeons,

I have a series of questions, regarding SCUBA diving safety, my daily activities causing further damage, the potential for recovery of hand use and frequencies for MRIs.

A year ago in March I had a Staph.  aureus infection on my cervical spinal cord (SC) which was diagnosed by puncturing my disk at C6-C7, sampling the bug, and then treated by antibiotics.  Immediate results of the infection were paralysis, but treatment of the bug decompressed the SC and allowed me to regain effectively full function a few months later.  Unfortunately, before its final demise, the infection entered the puncture point at the disk and then vertebral bone (C6-C7), causing disk dissolution, bone collapse and now some continued pressure on the SC.  My doctor here thought it was stable, as recalcification had started by May, but for unknown reasons, it all shifted in November, pinching off the nerve roots to my hands and continuing pressure on the SC.  I had a stabilization operation in December with excision of the damaged parts of vertebrae C6 &C7, replacement with hip bone and stabilization with a titanium strut from C5-C8 (ventral neck entry).  The surgery halted further degeneration,  but I still have a very weakly functional left hand and not normal strength, but largely functional, right hand.  I also have some compression on my SC, as evidenced by stiffness in my legs and some urge incontinence, and verified in an MRI.

My first question concerns SCUBA diving.  I am a biologist who does my research diving in East Africa.  Last summer I did not dive, but was able to do some field work snorkeling, leaving the SCUBA work to my students.  I am again going to do my field work, and asked my neurosurgeon about whether I could dive safely  now with my bionic neck and he replied "I don

[CCF-Neuro-M.D.-RPS]

Dear EM:

Sorry you had a serious bacteria infection.  Scuba diving should be okay but as your neurosurgeon told you, increased axial stress would place you at increased risk of further damage.  Water is a good medium for exercise as it allows for some increased stability, especially for the heavier weight of the head on the cervical spine.  This is not to say that your should be doing abnormal things to put your neck at risk.  Likely the added nerve problems are due to the healing process itself as inflamation (inflammation) and subsequent healing can change boney structures.  The degree of compromise depends on many factors which are somewhat individual, type of injury, type and extent of surgery, individual activity of the healing process, etc so prognostication is impossible without knowing and examining you and the lesion.  Most of what you can and cannot do is pretty much logical and common sense is needed, as you point out.  I can't tell you if further surgery will help or not.  But if the nerve is compromised one must think that it might help.  The question of the MRI is probably one of whay will the MRI show that your clinical status will not.  If your symptoms are getting worse, then certainly an examination is warranted.  If you symptoms are getting better then what will the MRI show that your symptoms are not telling you.  Common sense and logical should be used.  I hope your condition improves.

Sincerely,

CCF Neuro MD

[nor]

CCF Neurosurgeons - Thanks for your rapid reply!  Your answer, as that of my doc here, doesn't specifically address pressure effects, and I'm concerned that the tripling of overall pressure on the body might have untoward consequences for what I imagine might be a fairly delicate squeeze for my nerves in the compressed SC and nerve roots for the hands.   At 66 feet water depth overall pressure is 3 atm.  Parts of the body with different densities of media (most obviously the gas filled parts like eustacian tubes or sinuses) can be differentially affected.  However, the pressure increase is constant over the whole body at once, so perhaps its not a problem.  That, perhaps, is the crux of my question.  
Is there a way to locate a diving neurologist (as there are specialities in diving medicine in general)?

Despite my worried tone I'm really hoping you'll say its o.k. to dive, as I work in Lake Tanganyika, an incredibly interesting and gorgeous place to dive!

[DMT]

Dear EM

Firstly can I wish you all the best in the future with your compressed SC complication.  

I have recently undergone surgery following a C7 crush fracture as a result of an unwise swimming pool dive.  I am slightly more to blame for my injuries, but none the less now in a very unforeseen and somewhat daunting situation.  Surgery went well with allograft and plate between C6 & T1 and I'm now two weeks away from what I hope will be my final MRI scan to confirm fusion.

So far I have been lucky with only minor strength loss in my left arm, but I'm keen to understand possibly long-term weakness and susceptibility of my SC.  Although Scuba diving is not something I've yet had the opportunity to try, I am very keen given more physical activities may now be out of bounds.  Therefore any feedback from your scuba diving experience would be gratefully appreciated.

I have been told that Skiing, one of my favourite past times may still be allowable with little or no increased risk than anyone else.  Assuming full fusion is successful can anyone comment on this advice and how much time I should leave before the risk is negligible.

Many thanks & good luck EM
DMT