Management of thoracic spinal cord injury in a professional American football athlete: illustrative case

Maroon, Joseph C.; Agarwal, Nitin; Harrington, Amanda L.; Agarwal, Vikas; Norwig, John; Okonkwo, David O.

doi:10.3171/case21206

Cited by 2 publications

(2 citation statements)

References 30 publications

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“…In this regard, a recent review of HBO clinical trials in SCI to date commented that the quality of the trials has been “poor” and “further studies are needed” [ 45 ]. Currently HBO continues to be used in clinical treatment, as evidenced by a recent case study of an American football player who suffered a SCI during competition [ 46 ]. The patient showed remarkable recovery, although it was not possible to attribute the recovery to HBO therapy vs. other aspects of his clinical care.…”

Section: Discussionmentioning

confidence: 99%

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Oxygen therapy attenuates neuroinflammation after spinal cord injury

Sunshine,

Bindi,

Nguyen

et al. 2023

J Neuroinflammation

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Acute hyperbaric O2 (HBO) therapy after spinal cord injury (SCI) can reduce inflammation and increase neuronal survival. To our knowledge, it is unknown if these benefits of HBO require hyperbaric vs. normobaric hyperoxia. We used a C4 lateralized contusion SCI in adult male and female rats to test the hypothesis that the combination of hyperbaria and 100% O2 (i.e. HBO) more effectively mitigates spinal inflammation and neuronal loss, and enhances respiratory recovery, as compared to normobaric 100% O2. Experimental groups included spinal intact, SCI no O2 therapy, and SCI + 100% O2 delivered at normobaric pressure (1 atmosphere, ATA), or at 2- or 3 ATA. O2 treatments lasted 1-h, commenced within 2-h of SCI, and were repeated for 10 days. The spinal inflammatory response was assessed with transcriptomics (RNAseq) and immunohistochemistry. Gene co-expression network analysis showed that the strong inflammatory response to SCI was dramatically diminished by both hyper- and normobaric O2 therapy. Similarly, both HBO and normobaric O2 treatments reduced the prevalence of immunohistological markers for astrocytes (glial fibrillary acidic protein) and microglia (ionized calcium binding adaptor molecule) in the injured spinal cord. However, HBO treatment also had unique impacts not detected in the normobaric group including upregulation of an anti-inflammatory cytokine (interleukin-4) in the plasma, and larger inspiratory tidal volumes at 10-days (whole body-plethysmography measurements). We conclude that normobaric O2 treatment can reduce the spinal inflammatory response after SCI, but pressured O2 (i.e., HBO) provides further benefit.

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Section: Discussionmentioning

confidence: 99%

“…HBO therapy for SCI has been described in the literature for > 50 years [ 1 ], and is still used in persons with SCI [ 46 ]. However, HBO is has not been widely adopted as a therapeutic approach in SCI, as a deeper understanding of the underlying physiological mechanisms and functional impact is needed.…”

Section: Discussionmentioning

confidence: 99%

Oxygen therapy attenuates neuroinflammation after spinal cord injury

Sunshine,

Bindi,

Nguyen

et al. 2023

J Neuroinflammation

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Successful treatment of neurologic injury after complex spinal surgery with hyperbaric oxygen therapy: a case report

Brenna¹,

Khan²,

Katznelson³

et al. 2023

J Spine Surg

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Background Neurologic injury is relatively common in the context of spinal surgery, and is often treated with physiotherapy, pharmacotherapy, or surgical intervention. Emerging evidence supports a possible role for hyperbaric oxygen therapy (HBOT) in the treatment of peripheral and spinal nerve injuries. We describe the successful use of HBOT in improving neurologic recovery after complex spine surgery with new-onset postoperative unilateral foot drop. Case Description A 50-year-old woman was found to have new right-sided foot drop and L2-S1 motor deficits following complex thoracolumbar revision spinal surgery. She received standard conservative management for a provisional diagnosis of acute traumatic nerve ischemia, but demonstrated no neurologic improvement. On postoperative day four, after other avenues of treatment were exhausted, she was referred for HBOT. The patient received a total of twelve sessions of HBOT at 2.0 absolute atmospheres (ATA) of pressure, for 90 minutes (including two air breaks) per session, before transfer to a rehabilitation facility. Conclusions The patient displayed marked neurologic improvement after the first hyperbaric session, and further recovery thereafter. She concluded therapy with a significantly improved range of motion and lower limb power, ability to ambulate, and pain control. HBOT was associated with a rapid, sustained improvement when applied in this case as a salvage therapy for persistent postoperative neurologic deficit. Mounting evidence supports the consideration of hyperbaric therapy as a standard adjunct treatment for traumatic neurologic injury.

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Management of thoracic spinal cord injury in a professional American football athlete: illustrative case

Cited by 2 publications

References 30 publications

Oxygen therapy attenuates neuroinflammation after spinal cord injury

Oxygen therapy attenuates neuroinflammation after spinal cord injury

Successful treatment of neurologic injury after complex spinal surgery with hyperbaric oxygen therapy: a case report

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