The Treatment of Perioperative Spinal Cord Injury with Hyperbaric Oxygen Therapy: A Case Report.

STUDY DESIGN: Case Report (level IV evidence). OBJECTIVE: To describe a potential novel application of Hyperbaric Oxygen Therapy (HBOT) in the successful treatment of a post-operative spinal cord injury. SUMMARY OF BACKGROUND DATA: A 68 year old man presented with an acute spinal cord injury (ASIA impairment scale D), on the background of degenerative lower thoracic and lumbar canal stenosis. He underwent emergent decompression and instrumented fusion (T9 to L5), with an uncomplicated intra-operative course and no electrophysiological changes. Immediate post-operative assessment demonstrated profound bilateral limb weakness (1/5 on the Medical Research Council [MRC] grading scale, ASIA impairment scale B), without radiological abnormality. METHODS: Conventional medical management (hypertension, level 2 care) was instigated with the addition of Riluzole, with no effect after 30 hours. At 36 hours 100% oxygen at 2.8 atmospheres was applied for 90 minutes, and repeated after 8 hours, with a further 3 treatments over 48 hours. RESULTS: The patient demonstrated near-immediate improvement in lower limb function to anti-gravity (MRC grading 3/5) after 1 treatment. Motor improvement continued over the following treatments, and after 2 weeks the patient was ambulatory. At 4 months, the patient demonstrated normal motor function with no sphincteric disturbance. CONCLUSION: The application of HBOT contributed to the immediate and sustained improvement (ASIA B to ASIA E) in motor recovery after post-operative spinal cord injury. HBOT may represent a new avenue of therapy for spinal cord injury, and requires further prospective investigation. LEVEL OF EVIDENCE: 4.