Hyperbaric oxygen treatment: functional and neurological recovery, following spinal cord injury
Keywords:
hyperbaric oxygen, spinal cord injury
Abstract
Spinal Cord Injury (SCI) is an urgent condition with a high rate of clinical disability. Therefore, it is mandatory for clinical research to find effective therapies to recover from SCI and improve mobility and sensation. The purpose of this study is to review the use of hyperbaric oxygen in the functional and neurological rehabilitation of SCI patients. This is a narrative literature review. The following keywords were searched in the PUBMED literature: “hyperbaric oxygen” AND “spinal cord injury”. Inclusion criteria were clinical trials and animal studies investigating the use of hyperbaric oxygen in spinal cord injury recovery. Non-English language studies, systematic reviews, case reports, in vitro studies and research protocols were excluded from the study. Search results showed 100 posts. After checking titles and abstracts, 28 articles were rejected. Of the 72 publications evaluated, 10 were rejected for various reasons, leaving 62 studies (51 animal studies and 11 human studies) for the present review. Hyperbaric oxygen treatment has been found to have neuroprotective properties when administered after SCI. Animal studies have shown promising results and revealed various mechanisms contributing to these neuroprotective effects, including reduction of neuronal inflammation and apoptosis, reduction of oxidative stress, reduction of spinal cord edema and improvement of angiogenesis and autophagy. However, the number of clinical studies is rather small, with small sample sizes, showing various results. Regarding the use of hyperbaric oxygen treatment after SCI, the optimal timing, duration, frequency and pressure of hyperbaric oxygen treatment after SCI has not been clarified. Further high quality human studies are needed to fully elucidate the role of hyperbaric oxygen therapy in SCI management.
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References
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2. Chay W, Kirshblum S. Predicting Outcomes After Spinal Cord Injury. Phys Med Rehabil Clin N Am. 2020 Aug;31(3):331-43.
3. Galeiras Vázquez R, Ferreiro Velasco ME, Mourelo Fariña M, Montoto Marqués A, Salvador de la Barrera S. Update on traumatic acute spinal cord injury. Part 1. Med Intensiva. 2017 May;41(4):237-47.
4. Sekhon LH, Fehlings MG. Epidemiology, demographics, and pathophysiology of acute spinal cord injury. Spine (Phila Pa 1976). 2001 Dec 15;26(24 Suppl):S2-12.
5. Wang Y, Zhang S, Luo M, Li Y. Hyperbaric oxygen therapy improves local microenvironment after spinal cord injury. Neural Regen Res. 2014 Dec 15;9(24):2182-8.
6. Thom SR. Hyperbaric oxygen: its mechanisms and efficacy. Plast Reconstr Surg. 2011 Jan;127 Suppl 1(Suppl 1):131S-41S.
7. Emery E, Aldana P, Bunge MB, Puckett W, Srinivasan A, Keane RW, et al. Apoptosis after traumatic human spinal cord injury. J Neurosurg. 1998 Dec;89(6):911-20.
8. Tator CH, Fehlings MG. Review of the secondary injury theory of acute spinal cord trauma with emphasis on vascular mechanisms. J Neurosurg. 1991 Jul;75(1):15-26.
9. Patel NP, Huang JH. Hyperbaric oxygen therapy of spinal cord injury. Med Gas Res. 2017 Apr-Jun;7(2):133-43.
10. Ahmadi F, Zargari M, Nasiry D, Khalatbary AR. Synergistic neuroprotective effects of hyperbaric oxygen and methylprednisolone following contusive spinal cord injury in rat. J Spinal Cord Med. 2021 Apr 8:1-10.
11. Chen H, Xu G, Wu Y, Wang X, Wang F, Zhang Y. HBO-PC Promotes Locomotor Recovery by Reducing Apoptosis and Inflammation in SCI Rats: The Role of the mTOR Signaling Pathway. Cell Mol Neurobiol. 2021 Oct;41(7):1537-47.
12. Cristante AF, Damasceno ML, Barros Filho TE, de Oliveira RP, Marcon RM, da Rocha ID. Evaluation of the effects of hyperbaric oxygen therapy for spinal cord lesion in correlation with the moment of intervention. Spinal Cord. 2012 Jul;50(7):502-6.
13. Dayan K, Keser A, Konyalioglu S, Erturk M, Aydin F, Sengul G, et al. The effect of hyperbaric oxygen on neuroregeneration following acute thoracic spinal cord injury. Life Sci. 2012 Feb 27;90(9-10):360-4.
14. Falavigna A, Figueiró MP, Silva PGD, Conzatti LP, Rizkalla EB, Santos SCD, et al. Hyperbaric Oxygen Therapy After Acute Thoracic Spinal Cord Injury: Improvement of Locomotor Recovery in Rats. Spine (Phila Pa 1976). 2018 Apr 15;43(8):E442-E7.
15. Geng CK, Cao HH, Ying X, Yu HL. Effect of mesenchymal stem cells transplantation combining with hyperbaric oxygen therapy on rehabilitation of rat spinal cord injury. Asian Pac J Trop Med. 2015 Jun;8(6):468-73.
16. Geng CK, Cao HH, Ying X, Zhang HT, Yu HL. The effects of hyperbaric oxygen on macrophage polarization after rat spinal cord injury. Brain Res. 2015 May 5;1606:68-76.
17. Higgins AC, Pearlstein RD, Mullen JB, Nashold BS, Jr. Effects of hyperbaric oxygen therapy on long-tract neuronal conduction in the acute phase of spinal cord injury. J Neurosurg. 1981 Oct;55(4):501-10.
18. Hillard VH, Peng H, Das K, Murali R, Moorthy CR, Etlinger JD, et al. Inhibition of x-irradiation-enhanced locomotor recovery after spinal cord injury by hyperbaric oxygen or the antioxidant nitroxide tempol. J Neurosurg Spine. 2007 Apr;6(4):337-43.
19. Hou YN, Ding WY, Shen Y, Yang DL, Wang LF, Zhang P. Effect of hyperbaric oxygen on MMP9/2 expression and motor function in rats with spinal cord injury. Int J Clin Exp Med. 2015;8(9):14926-34.
20. Huang G, Diao J, Yi H, Xu L, Xu J, Xu W. Signaling pathways involved in HSP32 induction by hyperbaric oxygen in rat spinal neurons. Redox Biol. 2016 Dec;10:108-18.
21. Huang G, Xu J, Xu L, Wang S, Li R, Liu K, et al. Hyperbaric oxygen preconditioning induces tolerance against oxidative injury and oxygen-glucose deprivation by up-regulating heat shock protein 32 in rat spinal neurons. PLoS One. 2014;9(1):e85967.
22. Huang H, Xue L, Zhang X, Weng Q, Chen H, Gu J, et al. Hyperbaric oxygen therapy provides neuroprotection following spinal cord injury in a rat model. Int J Clin Exp Pathol. 2013;6(7):1337-42.
23. Kahraman S, Düz B, Kayali H, Korkmaz A, Oter S, Aydin A, et al. Effects of methylprednisolone and hyperbaric oxygen on oxidative status after experimental spinal cord injury: a comparative study in rats. Neurochem Res. 2007 Sep;32(9):1547-51.
24. Kang N, Hai Y, Yang J, Liang F, Gao CJ. Hyperbaric oxygen intervention reduces secondary spinal cord injury in rats via regulation of HMGB1/TLR4/NF-κB signaling pathway. Int J Clin Exp Pathol. 2015;8(2):1141-53.
25. Liang F, Li C, Gao C, Li Z, Yang J, Liu X, et al. Effects of hyperbaric oxygen therapy on NACHT domain-leucine-rich-repeat- and pyrin domain-containing protein 3 inflammasome expression in rats following spinal cord injury. Mol Med Rep. 2015 Jun;11(6):4650-6.
26. Liu F, Yang L, Liu J, Zhao Y, Xiao Z, Zheng Y, et al. Evaluation of hyperbaric oxygen therapy for spinal cord injury in rats with different treatment course using diffusion tensor imaging. Spinal Cord. 2019 May;57(5):404-11.
27. Liu M, Chen H, Tong M, Zhou J, Wu X. Effects of Ultra-early Hyperbaric Oxygen Therapy on Femoral Calcitonin Gene-Related Peptide and Bone Metabolism of Rats With Complete Spinal Transection. Spine (Phila Pa 1976). 2018 Aug;43(16):E919-E26.
28. Liu M, Wu X, Tong M, Zhou J. Impacts of Ultra-early Hyperbaric Oxygen Therapy on Bone Mass of Rats With Complete Spinal Cord Transection. Spine (Phila Pa 1976). 2016 Jul 15;41(14):E837-E43.
29. Liu X, Li C, Liang F, Wang Y, Li Z, Yang J. Effects of hyperbaric oxygen on glucose-regulated protein 78 and c-Jun N-terminal kinase expression after spinal cord injury in rats. Int J Clin Exp Med. 2015;8(3):3309-17.
30. Liu X, Liang F, Song W, Diao X, Zhu W, Yang J. Effect of Nrf2 signaling pathway on the improvement of intestinal epithelial barrier dysfunction by hyperbaric oxygen treatment after spinal cord injury. Cell Stress Chaperones. 2021 Mar;26(2):433-41.
31. Liu X, Liang F, Zhang J, Li Z, Yang J, Kang N. Hyperbaric Oxygen Treatment Improves Intestinal Barrier Function After Spinal Cord Injury in Rats. Front Neurol. 2020;11:563281.
32. Liu X, Wang J, Li G, Lv H. Effect of combined chondroitinase ABC and hyperbaric oxygen therapy in a rat model of spinal cord injury. Mol Med Rep. 2018 Jul;18(1):25-30.
33. Liu X, Yang J, Li Z, Liang F, Wang Y, Su Q, et al. Hyperbaric Oxygen Treatment Protects Against Spinal Cord Injury by Inhibiting Endoplasmic Reticulum Stress in Rats. Spine (Phila Pa 1976). 2015 Dec;40(24):E1276-83.
34. Liu X, Zhou Y, Wang Z, Yang J, Gao C, Su Q. Effect of VEGF and CX43 on the promotion of neurological recovery by hyperbaric oxygen treatment in spinal cord-injured rats. Spine J. 2014 Jan;14(1):119-27.
35. Long Y, Liang F, Gao C, Li Z, Yang J. Hyperbaric oxygen therapy reduces apoptosis after spinal cord injury in rats. Int J Clin Exp Med. 2014;7(11):4073-81.
36. Lu PG, Feng H, Yuan SJ, Zhang RW, Li M, Hu R, et al. Effect of preconditioning with hyperbaric oxygen on neural cell apoptosis after spinal cord injury in rats. J Neurosurg Sci. 2013 Sep;57(3):253-8.
37. Lu PG, Hu SL, Hu R, Wu N, Chen Z, Meng H, et al. Functional recovery in rat spinal cord injury induced by hyperbaric oxygen preconditioning. Neurol Res. 2012 Dec;34(10):944-51.
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