A Case History. Treatment of Cauda Equina Injury with Hyperbaric Oxygen Therapy.
The use of hyperbaric oxygen therapy in nerve injury has been the under investigation in the Peripheral Nerve Laboratory of the Mayo Clinic. This patient was run over by a four by four off-road vehicle and sustained a fracture dislocation at L4,5. He had surgery in a specialist unit within an hour and, fortunately, good fixation was achieved with a stainless steel implant. Post-operatively he was paraplegic with no bladder or bowel control and there was considerable edema requiring drainage.
The family contacted me about hyperbaric oxygen therapy and fortunately after a full explanation the surgeon and the health authorities agreed to his release from the surgical unit. I had been able to organise a Russian monoplace chamber, which was ideal, and treatment was undertaken on an outpatient basis. The patient had some difficulty understanding the rationale, but was resigned to yet another medical intervention. He had daily sessions of one hour at 2 atm abs for three weeks starting on day three post-operatively. I saw him at the end of the first week of treatment and he had begun to weight bear and there was some movement in both legs, but he still required a catheter. Rocky, the patient, although initially apprehensive was soon convinced of the benefits as the pain clearly reduced during the time in the chamber and he soon slept through the sessions. The outcome has been superb. He has full movement power, sensation and normal bladder and bowel function. He was so keen to get in the chamber that in the third week he actually attempted it without assistance. You may be critical of our patient supervision, but his first attempt took us completely by surprise. He stood up balanced on the gurney and jumped. However his feet slipped on the polished floor - and he landed in a heap. Fortunately litigation could not be further from his mind - Rocky is a dog - a german shepherd - who now wags his tale furiously at the mention of a chamber.
Dr. Philip James
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