Application of hyperbaric oxygen therapy in the treatment of spinal cord injury: insights from preclinical to clinical evidence

Peng, Songyang1,#; Zeng, Lin1,#; Lu, Bing2; Li, Qizheng3,*

Author Information

1Department of Neurosurgery, Hospital of Chengdu University of Traditional Chinese Medicine, Chengdu, Sichuan Province, China

2Department of Neurosurgery, Sichuan Provincial People’s Hospital, University of Electronic Science and Technology of China, Chengdu, Sichuan Province, China

3Department of Neurology, Hospital of Chengdu University of Traditional Chinese Medicine, Chengdu, Sichuan Province, China

*Correspondence to: Qizheng Li, MS, 48748296@qq.com.

#Both authors contributed equally to this work.

Abstract

Spinal cord injury (SCI) is a severe trauma that leads to significant motor, sensory, and autonomic dysfunction, imposing a substantial disease burden and economic costs globally. The pathophysiology of SCI involves primary and secondary injury stages, with the latter characterized by inflammatory responses, apoptosis, and tissue necrosis. Current therapeutic interventions, including pharmacological treatments and stem cell therapies, provide limited benefits and do not fully address the therapeutic effects on SCI. Hyperbaric oxygen therapy (HBOT), which delivers 100% oxygen at pressures exceeding 1 atmosphere absolute, has shown potential in SCI animal models due to its antiapoptotic, antioxidant, anti-inflammatory, and angiogenesis-promoting effects, thereby limiting secondary injury. Clinical studies have also demonstrated some efficacy of HBOT in treating SCI; however, the optimal timing, duration, and treatment cycles of HBOT remain contentious, and long-term efficacy has yet to be assessed. This review synthesizes the basic research and clinical practice of HBOT for SCI, thereby summarizing the main mechanistic pathways and demonstrating its clinical effects. Future large-scale, multicenter clinical studies are warranted to determine the efficacy and safety of HBOT in treating SCI and explore combined therapeutic modalities for a more comprehensive treatment approach.

摘要

脊髓损伤是一种严重的创伤，可导致显著的运动、感觉和自主神经功能障碍，给全球带来沉重的疾病负担和经济损失。脊髓损伤的病理生理过程涉及原发性和继发性损伤阶段，其中继发性损伤以炎症反应、细胞凋亡和组织坏死为特征。目前的治疗干预措施，包括药物治疗和干细胞疗法，效果有限，未能完全解决脊髓损伤的治疗问题。高压氧治疗（HBOT）是指在超过1个绝对大气压的压力下输送100%的氧气，由于其具有抗凋亡、抗氧化、抗炎和促进血管生成的作用，从而限制继发性损伤，已在脊髓损伤动物模型中显示出潜力。临床研究也证实了HBOT治疗脊髓损伤的一定疗效；然而，HBOT的最佳治疗时机、持续时间和治疗周期仍存在争议，且其远期疗效尚待评估。本综述整合了HBOT治疗脊髓损伤的基础研究与临床实践，总结了其主要的作用机制通路，并阐述了其临床效果。未来需要进行大规模、多中心的临床研究，以确定HBOT治疗脊髓损伤的有效性和安全性，并探索联合治疗模式，以期获得更全面的治疗方案