What Is Spinal Cord Ischaemia?
Spinal cord ischaemia is an ischaemic injury of the spinal cord caused by an inadequate blood supply through the spinal arteries or their feeding vessels. It is less common than cerebral ischaemia but is an exceptionally serious condition. Its clinical presentation depends on the level of the injury—cervical, thoracic or lumbar—and the extent of the ischaemic area.
It usually presents with the sudden onset of motor deficits, such as paraplegia or quadriplegia, together with sensory disturbances below the level of the injury and autonomic dysfunction, including bladder and bowel disturbances.
Causes include aortic aneurysm or dissection, complications of vascular surgery, embolism, spinal injury and vasculitis. The prognosis depends critically on how quickly blood flow is restored and rehabilitation is initiated.
Characteristics of the Spinal Cord
Like the brain, the spinal cord is extremely vulnerable to oxygen deprivation. Neurons and nerve fibres at the level of the injury may undergo rapid necrosis when ischaemia is complete or remain in a state of functional suppression when ischaemia is partial or transient.
An important characteristic of spinal cord ischaemia is that the initial neurological deficit may overestimate the true extent of permanent injury. Many neurons that appear functionally inactive are not necessarily dead but may remain in a state of “electrical silence”, from which they may recover if adequate oxygenation and biological support are provided promptly.
Scientific Evidence
The scientific evidence supporting the use of hyperbaric oxygen therapy in spinal cord ischaemia is based on both experimental animal studies and clinical reports.
Studies using experimental models of spinal cord ischaemia have demonstrated a significant reduction in neuronal apoptosis, improved vascularisation of peri-lesional tissue and better functional recovery in animals treated with hyperbaric oxygen therapy after the ischaemic injury.
Clinical reports involving patients who developed paraplegia following vascular procedures, particularly aortic surgery, have documented improvements in neurological function when hyperbaric oxygen therapy was introduced early in the postoperative period. These findings suggest that timely intervention may have a significant effect on the outcome.
The Role of Hyperbaric Oxygen Therapy
In spinal cord ischaemia, hyperbaric oxygen therapy is used as an adjunct to neurological management and rehabilitation. Its objectives are to limit the progression of tissue injury during the subacute phase, support the survival of neurons that remain functionally inactive and create more favorable conditions for neurological recovery.
By increasing the amount of oxygen dissolved in plasma, hyperbaric oxygen therapy helps overcome the effects of vascular insufficiency and delivers oxygen to spinal cord tissue independently of the condition of the local blood vessels.
It may also reduce spinal cord oedema, which can compress the cord and worsen the neurological deficit, while supporting mitochondrial function in neurons exposed to metabolic stress.
A typical treatment course consists of 30 to 50 sessions and is planned in collaboration with the neurologist and rehabilitation team.