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Related Experiment Video

Updated: Jul 29, 2025

Spinal Hernia Repair and Cauda Equina Repositioning After Lumbar Decompression under Three-Dimensional Microscopy: A Case Report and Literature Review
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Spinal Hernia Repair and Cauda Equina Repositioning After Lumbar Decompression under Three-Dimensional Microscopy: A Case Report and Literature Review

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Right-to-Left Shunt in Divers with Neurological Decompression Sickness: A Systematic Review and Meta-Analysis.

Spyros Peppas1, Leonidas Palaiodimos2,3, Sanjana Nagraj2,3

  • 1Department of Internal Medicine, MedStar Washington Hospital Center, Washington, DC 20010, USA.

Healthcare (Basel, Switzerland)
|May 27, 2023
PubMed
Summary

Right-to-left shunt (RLS) significantly increases the risk of neurological decompression sickness (NDCS) in divers. High-grade RLS showed a stronger association with NDCS, but RLS was not linked to asymptomatic brain lesions.

Keywords:
divingneurological decompression sicknessright-to-left shuntsilent brain lesions

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Area of Science:

  • Cardiovascular Physiology
  • Diving Medicine
  • Neurology

Background:

  • Neurological decompression sickness (NDCS) is a severe diving-related illness with potential for permanent neurological damage.
  • Observational studies suggest a link between right-to-left shunt (RLS) and neurological complications in divers, including NDCS and asymptomatic brain lesions.

Purpose of the Study:

  • To evaluate the association between the presence of right-to-left shunt (RLS) and neurological decompression sickness (NDCS).
  • To assess the relationship between RLS and asymptomatic brain lesions in divers.

Main Methods:

  • Systematic review of MEDLINE, Embase, and CENTRAL databases up to November 2021.
  • Meta-analysis using a random-effects model to calculate odds ratios (OR) for RLS prevalence in divers with and without NDCS or brain lesions.

Main Results:

  • Nine studies with 1830 divers were analyzed. RLS was more prevalent in divers with NDCS (62.6%) compared to those without (27.3%), with an OR of 3.83.
  • High-grade RLS was significantly associated with NDCS (OR: 4.98), particularly for inner ear DCS (OR: 12.13).
  • A higher prevalence of RLS was observed in divers with asymptomatic brain lesions (46.0%) versus those without (38.0%), but this finding was not statistically significant (OR: 1.53).

Conclusions:

  • Right-to-left shunt (RLS), especially high-grade RLS, is a significant risk factor for developing neurological decompression sickness (NDCS) in divers.
  • The study did not find a statistically significant association between RLS and asymptomatic brain lesions in the studied diving population.