Utilization, Utility and Variability in Usage of Adjunctive Hyperbaric Oxygen Therapy in Spinal Management: A Review of the Literature.

Abstract Purpose: The objective of this review was to understand the clinical utilization, utility, and variability in the usage of adjunctive HBOT. Surgical site infection is associated with high morbidity and mortality, increased healthcare expenditure, and decreased quality of life. With the increasing prevalence of adult spinal deformity and spinal fusion surgery, it is imperative to understand the potential benefits of adjunctive treatments. Hyperbaric oxygen therapy (HBOT) is a safe and common procedure indicated to treat various medical conditions. To do this, we conducted a literature search across 3 databases for English articles published between 12/1/2000 and 12/1/2019. Thirteen studies were included. HBOT may lessen the duration of antimicrobial therapy and mitigate instrument removal and revision surgery. The current usage indications for HBOT are supported by level III evidence for chronic osteomyelitis and level IV evidence for osteoradionecrosis. However, the same level of evidence exists to support the beneficial use of adjunctive HBOT for non-complicated spinal infections within 2 months post-surgery. When cultured, the most common organism was Staphylococcus aureus and other low-virulence organisms. The most common treatment protocol consists of 90-minute sessions of 100% FiO2 at 2-3 absolute atmospheres with a mean of 35.3 ±11.6 sessions for 5.2 ± 1.4 weeks. Adjunctive HBOT should be considered in select high-risk patients. Further improvements in diagnosis and categorization of spinal infections are necessary and will indelibly aid the decision making for the initiation of HBOT.