Abstract

The effects of hyperbaric Oxygen (HBO) therapy or methylprednisolone on the oxidative status were evaluated in experimental spinal cord injury. Clip compression method was used to produce acute spinal cord injury rats. Hyperbaric Oxygen was administered twice daily for a total of eight 90 min-sessions at 2.8 atmospheres. Methylprednisolone was first injected with a bolus of 30 mg/kg followed with an infusion rate of 5.4 mg/kg/h for 24 h. Five days after clip application animals were sacrificed and their traumatized spinal cord segment were excised. Tissue levels of thiobarbituric acid reactive substances (TBARS), superoxide dismutase (SOD) and glutathione peroxidase (GSH-Px) were evaluated to reflect oxidant/antioxidant status. Non-treated clip-operated animals reflected significantly higher SOD, GSH-Px and TBARS levels that were found to be significantly higher than the sham-operated. Methylprednisolone was not able to lower these levels. HBO administration diminished all measured parameters significantly; however, their levels appeared already to be high when compared with sham animals. According to these results obtained on the 5th day after induction, HBO, but not methylprednisolone, seems to procure prevention against oxidative spinal cord injury.

Abstract

A 49-year-old man underwent hyperbaric Oxygen (HBO) therapy for the treatment of primary spinal epidural abscess. Although the epidural abscess was initially treated with antibiotic (cefozopran) for 5 days, he subsequently developed motor weakness, paresthesia and urinary retention. MRI demonstrated spinal cord compression at the C1-C4 level. HBO therapy was added to the antibiotic regimen, and three days later we found clinical evidence of a response to treatment. Neurological symptoms were relieved 13 days after HBO therapy. This case suggests that HBO therapy is an effective therapeutic adjunct for the treatment of spinal epidural abscess.

Abstract

The aim of this study was to determine if the ischemic tolerance could be induced in the spinal cord by pretreatment with hyperbaric Oxygen (HBO) and what components of HBO (hyperoxia, hyperbaricity, and combination of these two) were critical in the induction of tolerance against ischemic injury.

METHODS:

In experiment 1, 21 rabbits were randomly assigned to one of three groups (n = 7 each): animals in the control group received no HBO before spinal cord ischemia; animals in the HBO-1 and HBO-2 groups received HBO (2.5 atmosphere absolute [ATA], 100% O2) pretreatment 1 h/day for 3 and 5 days before ischemia, respectively. In experiment 2, 48 rabbits were randomly assigned to one of four groups (n = 12 each): the control group received no HBO (21% O2, 1 ATA, 1 h/day, 5 days) before spinal cord ischemia; the HB group received 1-h treatment in 21% O2 at 2.5 ATA each day for 5 days; the HO group received 1-h treatment in 100% Oxygen at 1 ATA each day for 5 days; and the HBO group received HBO (2.5 ATA, 100% O2) treatment 1 h/day for 5 days. Twenty-four hours after the last treatment, spinal cord ischemia was induced by an infrarenal aorta clamping for 20 min. Forty-eight hours after reperfusion, hind-limb motor function and histopathology of the spinal cord were examined in a blinded fashion.

RESULTS:

In experiment 1, the neurologic outcome in the HBO-2 group was better than that of the control group (P = 0.004). The number of normal neurons in the anterior spinal cord in the HBO-2 group was more than that of the control group (P = 0.021). In experiment 2, the neurologic and histopathologic outcomes in the HBO group were better than that of the control group (P < 0.01). The histopathologic outcome in the HO group was better than that in the control group (P < 0.05).

CONCLUSIONS:

Serial exposure to high Oxygen (100%) tension induced ischemic tolerance in spinal cord of rabbits. Simple hyperbaricity (2.5 ATA, 21% O2) did not induce ischemic tolerance.

Abstract

The effectiveness of hyperbaric Oxygen therapy (HBO) in predicting neurological recovery in patients with spinal cord injury was evaluated. HBO has been used to treat spinal cord injury. This is the first report of the use of HBO as a diagnostic tool to evaluate neurological recovery after spinal cord injury. The study group consisted of 22 patients, aged 21-73 years, with spinal cord injuries. The effect of HBO was evaluated on admission and categorized as one of four grades (excellent, good, fair, or poor). The neurological status was evaluated on admission and at the time of follow-up, according to Frankel grade and the American Spinal Injury Association (ASIA) motor score. Correlations between the HBO effect and Frankel grade recovery and correlations between the HBO effect and recovery rate of the ASIA motor score were evaluated. The recovery in Frankel grade from admission to the final follow-up became better as the effectiveness of HBO increased (r = 0.445; P = 0.0414). The Frankel grade (r = 0.036; P = 0.871) and ASIA motor score (r = 0.029; P = 0.893) on admission did not correlate with the recovery in Frankel grade. There was a significant correlation between the HBO effect and the recovery rate of the ASIA motor score (r = 0.586; P = 0.0072), but this correlation was weaker than that for the ASIA motor score on admission (r = 0.752; P = 0.0006). We conclude that HBO can be employed to assess the status of spinal cord function recovery after spinal cord injury.

Abstract

Spinal cord ischemia sometimes causes paraplegia because the spinal motor neuron cells are vulnerable to ischemia. Although various protective remedies for spinal cord injury have been reported, there have been few established clinical methods. Although hyperbaric Oxygen (HBO) has been used clinically as a treatment for ischemia, the reason for its effectiveness is still uncertain because sufficient experimental data are lacking.

Twenty-three Japanese white rabbits, weighing 2-3 kg.

A modified rabbit spinal cord ischemia model of infrarenal aortic occlusion for 15 mins was employed. Rabbits were randomly assigned to four groups; the rabbits in group A did not undergo ischemic insults (n = 5). The rabbits in groups B and C underwent ischemic insult for 15 mins, followed by 1 hr of HBO treatment at 3 atm absolute with 100% Oxygen at 30 mins (n = 6) or 6 hrs (n = 7) after reperfusion, respectively. The rabbits in group D underwent ischemic insult for 15 mins without HBO treatment (n = 5).

MEASUREMENTS AND MAIN RESULTS: We observed neurologic functions for 14 days. The sections of the spinal cords were stained with hematoxylin and eosin, and the number of spinal motor neurons in ventral region was counted by light microscopy. All rabbits in groups A and B could stand, whereas all rabbits in groups C and D showed irreversible paraplegia on days 2 and 14 after reperfusion. Spinal motor neurons in ventral gray matter in groups C and D decreased significantly compared with those in groups A and B.

CONCLUSIONS: HBO therapy shortly after ischemic insult had protective effects against ischemic spinal cord damage. However, delayed treatment with HBO did not change the prognosis.

Abstract

A retrospective study of spinal cord injury (SCI) treated with and without hyperbaric Oxygen (HBO) therapy.

METHODS: Thirty-four cases of hyperextension spinal cord injury without bone damage and previous history of surgical intervention were divided into two groups, with (HBO) or without (non-HBO) therapy. The neurological findings at admission and their outcomes were evaluated by means of Neurological Cervical Spine Scale (NCSS)1 and the average improvement rates in individual groups were compared.

RESULTS: The improvement rate ranged from 100% to 27.3% with the mean value of 75. 2% in the HBO group, while these values were 100%, 25.0% and 65.1% respectively in the non HBO group.

CONCLUSION: In the HBO group, the improvement rate indicated effectiveness in acute traumatic cervical spinal cord injury.

Abstract

Acute spinal cord ischemic injury after resection of thoracoabdominal aneurysm remains a relatively common and potentially devastating complication. The complete resolution of postoperative paraplegia after resection of a type II thoracoabdominal aneurysm, after treatment with hyperbaric Oxygenation, is reported.

Abstract

The effectiveness of hyperbaric Oxygen therapy (HBO) in predicting the recovery after surgery in patients with cervical compression myelopathy was evaluated.

HBO has been used to treat brain and spinal cord diseases, but the effect is generally temporary. This is the first paper to utilize HBO as a diagnostic tool to evaluate the functional integrity of the spinal cord.

The study group consisted of 41 cervical myelopathy patients aged 32-78 years. Before surgery, the effect of HBO was evaluated and was categorized as four grades. The severity of the myelopathy and the recovery after surgery were evaluated by the score proposed by the Japanese Orthopaedic Association (JOA score). The correlation between many clinical parameters including the HBO effect and the recovery rate of JOA score was evaluated. The recovery rate of JOA score was found to be 75.2 +/- 20.8% in the excellent group, 78.1 +/- 17.0% in the good group, 66.7 +/- 21.9% in the fair group and 31.7 +/- 16.4% in the poor group.

There was a statistically significant correlation between the HBO effect and the recovery rate of the JOA score after surgery (r = 0.641, P < 0.0001). The effect of HBO showed a high correlation with the recovery rate after surgery as compared to the other investigated parameters. HBO can be employed to assess the chance of recovery of spinal cord function after surgical decompression.

Abstract

Magnetic resonance imaging (MRI) has been performed to assess the efficacy of hyperbaric Oxygen (HBO) treatment on experimental spinal cord injury in a rat animal model. A moderately severe injury, similar to Type III injury seen in humans (Kulkarni et al. Radiology 164:837;1987) has been chosen for these studies. An improvement in the neurologic recovery (based on Tarlov scale) has been observed following HBO treatment over a period of 72 hr.

Based on MRI, HBO treatment appears to arrest the spread of hemorrhage and resolve edema.

Abstract

Hyperbaric Oxygen (HBO) has become a useful treatment in clinical diseases. All the treatment profiles (Death/Time) were performed under the safe limit of unit pulmonary toxicity dose (UPTD). Between June 1976 and December 1987, we had treated 1288 cases with HBO.

The effective rates (cure or improvement) were 97.5% for decompression sickness, 96.3% for chronic osteomylitis, 90% for chronic skin ulcer, 89.4% for crush injury, 81.3% for gas intoxication, 76.1% for burn injury, 73.3% for cerebrovascular accident, 57.1% for gas gangrene, 50% for retinal artery insufficiency, and 45.5% for head or spinal cord injury.

Only 3 patients suffered from Oxygen toxicity and relieved immediately. To the serious decompression sickness, the comparative study between the conventional treatment table and our modified table revealed increased cure rate (25.8% versus 50.0%, P less than 0.05), and decreased recurrence rate (16.1% versus 4.1%, P less than 0.05). In burn patients with 35-70% area involved and 15-45 years of age, the comparative analysis showed a reduced mortality rate of 6.8% for the HBO treated group as opposed to 14.8% for the non-HBO treated group, P less than 0.05.

Abstract

Studies on the experimental spinal contusion injury in animals confirm that posttraumatic ischemia contributes to central cystic necrosis or fibrosis occurring at the level of the spinal cord lesion.

Hyperbaric Oxygen (HBO) modifies the degree and extent of the pathology in the spinal cord of the experimental animals. HBO has been used for 45 patients with recent spinal cord injuries. The extent of recovery in 27 patients with upper motor neuron lesions treated with adequate HBO is reported. Fifteen of the 27 patients had useful functional recovery.

Abstract

Hyperbaric Oxygenation (HBO) in a pressure chamber with an Oxygen pressure of up to 2.8 absolute atmospheres administered to patients with various lesions of the spinal cord (trauma sequelae, discogenic ischemic myelopathy, states after tumor removal, etc.,) was frequently followed by a more or less pronounced regression of the existent neurological symptomatology. Pelvic and motor functions as well as sensitivity and reflexes returned to normal and the pain syndromes were alleviated. The therapeutic response to HBO is directly dependent on the role played by reversible functional lesions of the spinal cord in the general picture of the disease.

Abstract

Thirty adult, male, Long-Evans hooded rats underwent spinal cord transections at the T5 vertebral level. Following surgery, animals were separated into three groups: Group I received only normal postoperative care; Group II received daily hyperbaric Oxygen (HBO) treatments for 47-54 consecutive days; Group III received the same HBO treatment as Group II in addition to subcutaneous injections of dimethyl sulfoxide (DMSO) for 10 consecutive days.

All animals were killed 60-70 days postlesion. The lesioned area of spinal cord was removed and prepared for light and electron microscopy. Group I animals showed typical scar reduction of cavitations, increased scarring, and more nerve fibers within the lesion. Three animals in this group exhibited coordinated hindlimb movement, with one animal showing weight-bearing ability. The lesion sit in group III animals revealed a reduction in collagen formation and a further increase in the number of nerve fibers. Six animals in Group III showed coordinated hindlimb movements; among these two displayed weight-bearing ability and sensory return.

Abstract

To study the acute effects of hyperbaric Oxygen ventilation (HBO) on long-tract function following spinal cord trauma, the authors employed a technique for monitoring spinal cord evoked potentials (SCEP) as an objective measure of translesion neuronal conduction in cats subjected to transdural impact injuries of the spinal cord. Control animals subjected to injuries of a magnitude of 400 or 500 gm-cm occasionally demonstrated spontaneous return of translesion SCEP within 2 hours of injury when maintained by pentobarbital anesthesia and by ventilation with ambient room air at 1 atmosphere absolute pressure (1 ATA).

Animals sustaining corresponding injuries but receiving immediate treatment with HBO at 2 ATA for a period of 3 hours following impact demonstrated variable responses to this treatment modality. Animals sustaining injuries of 400 gm-cm magnitude showed recovery of translesion SCEP in four of five cases, while animals sustaining injuries of 500 gm-cm magnitude responded to HBO treatment by recovery of SCEP no more frequently than did control animals. When the onset of HBO therapy was delayed by 2 hours following impact, there appeared to be no demonstrable protective effect on long-tract neuronal conduction mediated by HBO alone.

The observations suggest that HBO treatments can mediate preservation of marginally injured neuronal elements of the spinal cord long tracts during the early phases of traumatic spinal cord injury. These protective effects may be based upon the reversal of focal tissue hypoxia, or by reduction of tissue edema.

HBO treatment markedly diminished the protective effects of HBO on long-tract neuronal conduction following traumatic spinal cord injury.

Abstract

This review examines, in a condensed manner, many of the major achievements related to spinal cord injury research during the last quarter century. Most of the advances have been made within the past 10 years. They include such basic and clinical tools as evoked potentials, regional and local spinal blood flows, neurophysiologic monitoring systems, and methods that detail the morphology and contents of cord tissue. Much of the experimentation conducted within the last 25 years has provided a better understanding and clinical therapeutic approach to the injured spinal cord than at any time before. Such work has exposed significant aspects in the biochemistry and vascular mechanics associated with trauma to the cord.

A growing and intriguing area of spinal injury research lies in probing the factors related to neuronal plasticity and regeneration of the cord tissue. This review also examines the role of experimental animal models as well as the clinical and experimental therapies available for acute and chronic spinal cord injury.

Abstract

While reports of the beneficial effects of hyperbaric Oxygen therapy in experimental use appear in the literature, there have been no reports of clinical trials with hyperbaric Oxygen therapy of acute spinal cord injury.

A series of treatment protocols have thus been designed for treatment of acute spinal cord injury utilizing hyperbaric Oxygen. The study has been in progress for the last two years and involved more than 50 patients; results from the therapy trial in 25 patients over the last 18 months will be presented in this preliminary report.

Hyperbaric Oxygen therapy was generally initiated approximately 7 1/2 hours following injury. Pretreatment and posttreatment motor scores were compared with those of patients given conventional therapy for acute spinal cord injury. Under these circumstances, patients receiving hyperbaric Oxygen therapy appeared to recover more quickly, although their final motor scores were about the same as those of patients receiving conventional therapy. Thus, alter the time course of recovery, perhaps without altering the final neurological outcome.