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Selected Publication:
Zajac, V.
Hyperbaric oxygenation (HBO) as a supportive measure during sub-acute to late-stage neurorehabilitation after traumatic spinal injuries
Humanmedizin; [ Diplomarbeit ] Graz Medical University; 2019. pp. 64
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- Authors Med Uni Graz:
- Advisor:
- Klemen Huberta
- Schmidt Barbara
- Smolle-Juettner Freyja-Maria
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- Abstract:
- Abstract Introduction: Any damage to the spinal cord causes changes in its function that may be temporary or permanent. Symptoms involve variable degrees of loss of motor function, of sensation, or of autonomic function in the regions of the body distal to the level of the injury. Due to inflammation cascades post-trauma, secondary damage with neuronal cell death mainly due to oedema and lipid peroxidation can dramatically worsen the outcome. In an abundance of animal experiments hyperbaric oxygenation (HBO), denoting breathing of 100% oxygen under elevated ambient pressure, has been found to downregulate inflammatory mediator cascades, to reduce oedema and counteract lipid peroxidation and cell death by a variety of molecular mechanisms. Furthermore HBO supports re-myelonization and minimizes glia-mediated inflammation and glial scar formation. In spite of the experimental data and a few clinical studies on hyperbaric oxygenation (HBO) treatment during the first 24 hours following spinal trauma, there are hardly any clinical data on sub-acute and late-phase HBO after spinal injuries. Materials and methods: Patients who had HBO at the hyperbaric facility of the Division for Thoracic and Hyperbaric Surgery, Medical University Graz within the last 10 years were reviewed. Those who had HBO under intention-to-treat indication for spinal trauma more than 24 hours after the accident were included into the analysis. In addition to the ASIA-score documenting both motoric deficits and sensory deficits, a 10-grade subjective VAS score for motoric, sensible and paraesthesia symptoms had been used. HBO treatment was delivered at 2,2 ata for 90 min 5 times a week with weekend breaks. The data was collected from electronical patients´ charts. For statistical analysis was Wilcoxon matched pair signed rank test and Spearman´s rank correlation test were used. Results: 12 patients with spinal cord injury (10 males, 2 females; mean age: 49,3; range: 19 – 69) were included into the study. Both degree and level of the injury varied considerably. Both subjectively and by objective evaluation each patient reported improvements during the course of HBO treatments, while none experienced any worsening of symptoms. Spearman’s rank correlation test showed a very high (92%) negative correlation between the duration of treatment the severity of symptoms. All 3 symptoms combined had a p=0,000 and when analysed by each individual symptom Spearman’s test showed a 92% correlation regarding motoric deficits and treatment time, an 81% correlation regarding sensible deficits and a 74% correlation for paraesthesia. The ASIA score showed a significant increase of both the sensory and motoric score (Wilcoxon matched pairs signed rank test: p = 0.0031). Eleven patients showed an improvement in both scores, one patient was improved in the sensory score and unchanged in the motoric score. In none of the patients a decrease of either score was found after HBO therapy. Conclusion: HBO seems to be effective in subacute spinal trauma. However, since there was no control group, it is not possible to state, whether the patients would have equally improved without HBO within the same time interval. Of note is the fact that in most cases there had been no clinical improvement until HBO was started. There is definitive need for prospectively randomized studies including large collectives of patients to further elucidate the effectiveness of HBO in spinal cord injury.