Prediction of neurologic outcome in patients with spinal cord injury by using hyperbaric oxygen therapy

antiquity · 02-18-2002, 03:26 AM

J Orthop Sci 2001;6(5):385-9
Prediction of neurologic outcome in patients with spinal cord injury by using hyperbaric oxygen therapy.

Ishihara H, Kanamori M, Kawaguchi Y, Osada R, Ohmori K, Matsui H.

Department of Orthopaedic Surgery, Toyama Medical and Pharmaceutical University, 2630 Sugitani, Toyama 930-0194, Japan.

The effectiveness of hyperbaric oxygen therapy (HBO) in predicting neurological recovery in patients with spinal cord injury was evaluated. HBO has been used to treat spinal cord injury, but HBO does not appear to greatly alter the neurological outcome. This is the first report of the use of HBO as a diagnostic tool to evaluate neurological recovery after spinal cord injury. The study group consisted of 22 patients, aged 21-73 years, with spinal cord injuries. The effect of HBO was evaluated on admission and categorized as one of four grades (excellent, good, fair, or poor). The neurological status was evaluated on admission and at the time of follow-up, according to Frankel grade and the American Spinal Injury Association (ASIA) motor score. Correlations between the HBO effect and Frankel grade recovery and correlations between the HBO effect and recovery rate of the ASIA motor score were evaluated. The recovery in Frankel grade from admission to the final follow-up became better as the effectiveness of HBO increased (r = 0.445; P = 0.0414). The Frankel grade (r = 0.036; P = 0.871) and ASIA motor score (r = 0.029; P = 0.893) on admission did not correlate with the recovery in Frankel grade. There was a significant correlation between the HBO effect and the recovery rate of the ASIA motor score (r = 0.586; P = 0.0072), but this correlation was weaker than that for the ASIA motor score on admission (r = 0.752; P = 0.0006). We conclude that HBO can be employed to assess the status of spinal cord function recovery after spinal cord injury.

judykerperien · 02-18-2002, 10:19 AM

ok someone put this in plain english for me, we have been lookinga at this as something to try, explain please

rbyrd49100 · 02-18-2002, 02:36 PM

Judy,

it would be unfair to expect them to release something we could actually understand

I think it may be saying that , if anything HBO might speed the recovery to help evaluate outcome. Steve had HBO, but was for his brain injury and it did help him with that. I have no idea what effect it may have had on his SCI.

I believe Dr Young posted something that showed it might actually be harmful to stem cells that were transplanted and that they performed better in less oxygen. So..with that line of thinking, might it be harmful in some cases to a recovering SCI?

Russ Byrd

Wise Young · 02-18-2002, 03:05 PM

This is a very subtle abstract and let me try to parse it out for you. Ishihara, et al. treated 22 patients with spinal cord injury, recording their motor scores (ASIA scores 0-100 points, 10 muscles on each side of the body, each muscle gets a grade of 0-5). They also recorded their Frankel grade (they really should call it the ASIA classification), i.e. A, B, C, D. A is complete, B is sensory incomplete, C is motor incomplete, and D is useful motor below the injury site.

They found that ASIA motor scores on admission predicted the extent of recovery. This is to be expected. We know that "incomplete" injuries tend to show more recovery than "complete" injuries.

Some of the patients showed improved motor scores and Frankel grade if they were treated with hyperbaric oxygen but not all of them. Those patients that showed improvements tended to be the most incomplete and they also showed the most long term recovery.

Because all the patients received HBO in this study, the authors did not have a placebo group to compare HBO-treated patients against. Therefore, they cannot claim that HBO is responsible for the better recovery of the patients.

They found that ASIA motor scores more reliable predictors of eventual recovery than response to HBO. The latter has a correlation coefficient of 0.586 (a perfect corrrelation is 1.000) and this roughly suggests that a little more than half of the patients that showed improved motor score or Frankel grade when exposed to HBO also went on to recover substantially.

These data are interesting in that it does suggest that HBO does improve function in some patients (presumably transiently). I can't tell from the abstract how long they treated the patients. The way the abstract is worded, it suggests that they treated them only for a short period, using the HBO more as a diagnostic tool rather than a treatment.

Wise.

Wise Young · 02-18-2002, 03:16 PM

One other point, the spinal cord injury population in Japan is different from that in the U.S. They have more older people who are injured and they are more likely to have arteriosclerosis and compromised blood flow to their spinal cord. Also, they have a more serious problem with a particular type of ligament that tends to compress the spinal cords. So, ischemia or lack of blood flow is likely to play a more important role in spinal cord injuries in Japan than in the U.S. It is possible that in Japan, more people would respond to HBO therapy than in the U.S.

On the other hand, as the authors pointed out, many attempts to treat spinal cord injury with HBO have not shown significant neurological improvement as a result of the therapy. This may be in part due to several factors that, in my opinion, has not been adequately addressed in all the clinical trials to date. Most of the clinical trials would put the patients into HBO chambers at 24-48 hours after injury. The story here may be similar to that of methylprednisolone. If you don't get the treatment within a few hours, it may be too late for impressive beneficial results.

Wise.

02-18-2002, 03:26 AM	#1
antiquity Moderator Join Date: Jul 2001 Posts: 14,540	Prediction of neurologic outcome in patients with spinal cord injury by using hyperbaric oxygen therapy J Orthop Sci 2001;6(5):385-9 Prediction of neurologic outcome in patients with spinal cord injury by using hyperbaric oxygen therapy. Ishihara H, Kanamori M, Kawaguchi Y, Osada R, Ohmori K, Matsui H. Department of Orthopaedic Surgery, Toyama Medical and Pharmaceutical University, 2630 Sugitani, Toyama 930-0194, Japan. The effectiveness of hyperbaric oxygen therapy (HBO) in predicting neurological recovery in patients with spinal cord injury was evaluated. HBO has been used to treat spinal cord injury, but HBO does not appear to greatly alter the neurological outcome. This is the first report of the use of HBO as a diagnostic tool to evaluate neurological recovery after spinal cord injury. The study group consisted of 22 patients, aged 21-73 years, with spinal cord injuries. The effect of HBO was evaluated on admission and categorized as one of four grades (excellent, good, fair, or poor). The neurological status was evaluated on admission and at the time of follow-up, according to Frankel grade and the American Spinal Injury Association (ASIA) motor score. Correlations between the HBO effect and Frankel grade recovery and correlations between the HBO effect and recovery rate of the ASIA motor score were evaluated. The recovery in Frankel grade from admission to the final follow-up became better as the effectiveness of HBO increased (r = 0.445; P = 0.0414). The Frankel grade (r = 0.036; P = 0.871) and ASIA motor score (r = 0.029; P = 0.893) on admission did not correlate with the recovery in Frankel grade. There was a significant correlation between the HBO effect and the recovery rate of the ASIA motor score (r = 0.586; P = 0.0072), but this correlation was weaker than that for the ASIA motor score on admission (r = 0.752; P = 0.0006). We conclude that HBO can be employed to assess the status of spinal cord function recovery after spinal cord injury.

02-18-2002, 10:19 AM	#2
judykerperien Senior Member Join Date: Oct 2001 Location: Campbell Mo usa Posts: 305	Help ok someone put this in plain english for me, we have been lookinga at this as something to try, explain please

02-18-2002, 02:36 PM	#3
rbyrd49100 Senior Member Join Date: Oct 2001 Posts: 516	plain english? Judy, it would be unfair to expect them to release something we could actually understand I think it may be saying that , if anything HBO might speed the recovery to help evaluate outcome. Steve had HBO, but was for his brain injury and it did help him with that. I have no idea what effect it may have had on his SCI. I believe Dr Young posted something that showed it might actually be harmful to stem cells that were transplanted and that they performed better in less oxygen. So..with that line of thinking, might it be harmful in some cases to a recovering SCI? Russ Byrd

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02-18-2002, 03:05 PM	#4
Wise Young Administrator Join Date: Jul 2001 Location: New Brunswick, NJ, USA Posts: 37,975	This is a very subtle abstract and let me try to parse it out for you. Ishihara, et al. treated 22 patients with spinal cord injury, recording their motor scores (ASIA scores 0-100 points, 10 muscles on each side of the body, each muscle gets a grade of 0-5). They also recorded their Frankel grade (they really should call it the ASIA classification), i.e. A, B, C, D. A is complete, B is sensory incomplete, C is motor incomplete, and D is useful motor below the injury site. They found that ASIA motor scores on admission predicted the extent of recovery. This is to be expected. We know that "incomplete" injuries tend to show more recovery than "complete" injuries. Some of the patients showed improved motor scores and Frankel grade if they were treated with hyperbaric oxygen but not all of them. Those patients that showed improvements tended to be the most incomplete and they also showed the most long term recovery. Because all the patients received HBO in this study, the authors did not have a placebo group to compare HBO-treated patients against. Therefore, they cannot claim that HBO is responsible for the better recovery of the patients. They found that ASIA motor scores more reliable predictors of eventual recovery than response to HBO. The latter has a correlation coefficient of 0.586 (a perfect corrrelation is 1.000) and this roughly suggests that a little more than half of the patients that showed improved motor score or Frankel grade when exposed to HBO also went on to recover substantially. These data are interesting in that it does suggest that HBO does improve function in some patients (presumably transiently). I can't tell from the abstract how long they treated the patients. The way the abstract is worded, it suggests that they treated them only for a short period, using the HBO more as a diagnostic tool rather than a treatment. Wise.

02-18-2002, 03:16 PM	#5
Wise Young Administrator Join Date: Jul 2001 Location: New Brunswick, NJ, USA Posts: 37,975	One other point, the spinal cord injury population in Japan is different from that in the U.S. They have more older people who are injured and they are more likely to have arteriosclerosis and compromised blood flow to their spinal cord. Also, they have a more serious problem with a particular type of ligament that tends to compress the spinal cords. So, ischemia or lack of blood flow is likely to play a more important role in spinal cord injuries in Japan than in the U.S. It is possible that in Japan, more people would respond to HBO therapy than in the U.S. On the other hand, as the authors pointed out, many attempts to treat spinal cord injury with HBO have not shown significant neurological improvement as a result of the therapy. This may be in part due to several factors that, in my opinion, has not been adequately addressed in all the clinical trials to date. Most of the clinical trials would put the patients into HBO chambers at 24-48 hours after injury. The story here may be similar to that of methylprednisolone. If you don't get the treatment within a few hours, it may be too late for impressive beneficial results. Wise.