In brief: A 26-year-old diver suffered spinal cord decompression sickness even though he did not exceed the time and depth limits set in standard US Navy diving tables. This case shows that when dives are strenuous and almost reach time and depth limits they may exceed the parameters of the tables. The case also illustrates the importance of rapid diagnosis and hyperbaric oxygen treatment of pressure-related diving casualties. The author says optimum treatment of decompression sickness depends on a high level of suspicion, an accurate diving history, and prompt treatment with hyperbaric oxygen.