The effect of peri-operative hyperbaric oxygen therapy on the recovery of neurologic function of patients with cervical spondylotic myelopathy: A diffusion tensor imaging study

Abstract

Objective To observe the clinical effect of hyperbaric oxygen therapy on cervical spondylotic myelopathy (CSM) in the peri-operative period, and to explore its neural mechanism. Methods Eighty patients who underwent surgical decompression for CSM were randomly divided into a hyperbaric oxygen group (n=40) and a control group (n=40). Both groups received cervical laminoplasty and systematic rehabilitation treatment after the surgery, while the hyperbaric oxygen group was additionally provided with hyperbaric oxygen therapy in the peri-operative period. The patients′ neurological status was evaluated using Japanese Orthopaedic Association (JOA) scores. Both groups received conventional MRI and diffusion tensor imaging (DTI) before and 6 months after the surgery. Results After the surgery, both groups gained significant improvement in their average JOA score, with the improvement of the hyperbaric oxygen group significantly greater than in the control group. Pearson correlation analysis showed that the average pre-operative JOA score was significantly correlated with the anisotropic fraction (FA) and the apparent dispersion coefficient (ADC) of the compressed spinal cord. Six months after the surgery such correlation still persisted. During the six months, significant increase was observed in the average FA and significant decrease in the average ADC in both groups, with the average FA of the hyperbaric oxygen group (0.726±0.087) significantly higher at the end of the 6 months than that in the control group. The average ADC (1.148±0.079)×10-3 mm2/s) was significantly lower. Conclusions DTI′s quantitative indicators can objectively show changes in the microstructure and pathological state of spinal cords. Exposure to hyperbaric oxygen may relieve ischemia and hypoxia of the spinal cord, promoting the repair of injured neurons and accelerating the regeneration of nerve fibers. Key words: Hyperbaric oxygen; Cervical spine; Spondylosis; Myelopathy; Laminoplasty; Diffusion tensor imaging