HBO & Chronic Spinal Cord
Injury
HBO & Stem-Cell Mobilization
Hyperbaric oxygen therapy (HBO) is most commonly used
to treat decompression sickness or the bends in divers who undergo rapid
decompression. Patients are placed in chambers pressurized at 2-3
atmospheres containing up to 100% oxygen (compared to 21% in the air we
breathe). This pressure allows the bubbles resulting from rapid
decompression to be reabsorbed.
Evidence from animal and human studies suggests that
HBO is beneficial for treating a variety of neurological disorders in
which blood-flow-related oxygenation may be compromised (i.e., ischemia),
including stroke, head injury, and acute and perhaps chronic SCI. The
therapeutic premise is that HBO will force oxygen into oxygen-deprived CNS
tissue resulting from injury. Dr. Wise Young (NJ, USA) has reviewed HBO
therapy, including potential SCI applications (http://carecure.rutgers.edu/spinewire/articles/HBOT2001.htm).
HBO has also been used to accelerate healing in SCI-associated pressure
sores.
HBO & Acute Spinal Cord Injury
1) In 1978, Dr. John Yeo
and colleagues (Australia) reported on the HBO treatment of 10
patients with acute SCI (Med J Aust 2(12), 1978). Eight and two
patients had quadriplegia and paraplegia, respectively, and three had
complete injuries. HBO treatment, consisting of two 90-minute,
2.5-atmospheres sessions, commenced within 14 hours of injury. Results
suggested that recovery of motor power in five patients was more rapid and
greater than would be expected from routine care.
In 1984, Yeo indicated that he had cumulatively
treated 45 acutely injured patients with HBO (Central Nervous System
Trauma 1(2), 1984), of whom results were reported for 27 with upper
motor neuron lesions. Of the 27, 78% and 22% had cervical and thoracic
injuries, respectively, and average age was 32. Patients received up to
three 90-minute, 2.5-atmospheric pressurizations starting 5-14 hours after
injury and were compared to 63 conventionally treated patients using the
Frankel assessment scale, the predecessor to today’s commonly used ASIA
scale.
Although 15 of the 27 patients had useful functional
recovery, overall no statistical difference was demonstrated between
treated and control patients. Yeo suggested, however, “the trend indicates
that the patient with an incomplete spinal cord injury may experience
additional functional recovery if treated with HBO… within hours of
injury.”
2) In 1978, Dr. Richard
Jones et al (Sydney, Australia) reported the results of treating nine
patients with HBO within 12 hours of injury (Med J Aust 2(12),
1978). Each patient had two 120-minute, 2.5-atmospheric sessions
(equivalent to a depth of 45-feet sea water) separated by an hour of
normal pressure breathing. Of the treated patients, several had functional
or neurological improvement.
3) In 1980, Dr.
Francis Gamache and colleagues (NY, USA) presented the preliminary
findings of treating 25 patients with HBO starting about 7.5 hours after
injury (Surgical Neurology. 15(2), 1981). Twenty-three were male;
19 and three had cervical and thoracic injuries, respectively; and age
averaged 24. Patients were treated for 90-120 minutes at 2.0-2.5
atmospheric pressure at intervals ranging initially from every two hours
to twice daily. Treatment was discontinued when improvement reached a
plateau. Patients were periodically evaluated for at least six months. The
investigators concluded that HBO accelerated recovery, though final
outcomes were comparable to those patients receiving conventional care.
4) Dr. M.P. Elinskii
and colleagues (Russia) concluded that 2.8-atmospheric-pressure HBO
therapy reduced neurological symptoms in patients with various spinal cord
lesions (Zh Neropatol Psikhiatry Im S S Korsakova 84(5), 1984).
5) Dr. S. Asamato
et al (Tokyo, Japan) retrospectively compared 34 patients with cervical,
hyperextension injuries who had and had not been treated with HBO therapy
(Spinal Cord, 38(9), 2000). In HBO-treated patients, improvement
ranged from 100% to 27.3% with a mean of 75.2%, whereby in the non-HBO
treated group, these values were 100%, 25%, and 65.1%, respectively. The
investigators concluded that the data “indicated effectiveness in acute
traumatic cervical injury.”
HBO & Chronic Spinal
Cord Injury
Various anecdotal reports indicate potential benefits
may accrue for individuals with chronic SCI. For example, an
Australian HBO program has reported functional improvement in several
patients with chronic SCI (www.spinalrehab.com.au/disorders/SpinalCordInjury.htm).
In one case, a 39-year old male had sustained C6-7 injury from an auto
accident and further developed a C6-T1 syringomyelia cyst. Several years
after injury, he commenced daily HBO therapy and reported as a result the
return of sensation in legs down to his toes, stomach, and back, as well
as the return of knee reflexes.
The second case involved a 20-year-old female who had
sustained a C5-6 injury from an auto accident. Before commencing HBO
therapy, her improvement had been minimal. In addition to HBO treatment,
she also received “assertive” physical therapy and electro-acupuncture,
both of which have been shown to promote functional recovery. In a diary,
she documented the incremental improvements she accrued over the course of
70 HBO pressurizations, which cumulatively were considerable, including
improved bowel-and-bladder and respiratory function, circulation,
pressure-sore healing, and sensation and motor control in extremities.
HBO & Stem-Cell
Mobilization
Numerous animal
studies suggest that HBO influences the expression of stem cells,
including 1) promoting differentiation and proliferation into neurons,
2) enhancing migration to areas of injury, 3) suppressing stem-cell
apoptosis, a form of programmed
cell death, and 4) inducing stem-cell growth factors. In humans,
Dr. Stephen Thom and
colleagues (USA) have shown that HBO therapy stimulates the bone-marrow
production of stem cells through a mechanism dependent on nitric oxide, a
chemical that plays a key role in the spinal cord injury process. Specifically, the
number of stem cells doubled in the circulation of humans after a single
two-hour, two-atmosphere HBO session, and after 20 treatments, increased
eight-fold.
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