title: Role of hyperbaric oxygen therapy in the treatment of bacterial spinal osteomyelitis.
abstract: OBJECTIVE
  Hyperbaric oxygen therapy (HBO) is used as primary and/or adjunctive therapy in the treatment of various clinical conditions complicated by local hypoxia. It may have therapeutic potential in the treatment of neurosurgical infections such as spinal osteomyelitis that are associated with significant morbidity rates. The purpose of this study was to evaluate the efficacy of HBO therapy in the treatment of spinal osteomyelitis.
  
  
  METHODS
  The clinical records of patients diagnosed with spinal osteomyelitis who received HBO therapy during their treatment at the authors' institution over the past 10 years were retrospectively reviewed. Six adult patients were identified. Four patients had recently undergone spinal surgery and secondary spinal osteomyelitis had developed. These patients received adjunctive HBO therapy due to significant comorbidities and risk factors for poor healing.
  
  
  RESULTS
  All patients remained symptom and infection free over the subsequent follow-up period. Two patients had primary spinal osteomyelitis that had recurred despite a full course of appropriate antimicrobial therapy. Infection control was achieved after HBO therapy in 1 patient. The mean follow-up period for the study group was 2.9 years (range 5 months to 5 years).
  
  
  CONCLUSIONS
  Hyperbaric oxygen therapy enabled infection cure in 5 of 6 patients with spinal osteomyelitis complicated by medical comorbidities or the failure of primary therapy. These results show that HBO may be a useful adjunctive therapeutic modality in the treatment of spinal osteomyelitis, particularly when there are medical comorbidities that increase the risk of poor healing. Hyperbaric oxygen therapy may also be beneficial in patients with relapsing primary spinal osteomyelitis after standard therapy has failed.
authors.affiliation: The University of Iowa, Department of Neurosurgery, Iowa City, Iowa, USA.
authors.forename: Raheel
authors.initials: R
authors.lastname: Ahmed
authors.forename: Meryl A
authors.initials: MA
authors.lastname: Severson
authors.forename: Vincent C
authors.initials: VC
authors.lastname: Traynelis
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D015897:Comorbidity; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D006931:Hyperbaric Oxygenation / Q000009:adverse effects / Q000706:statistics & numerical data; D008297:Male; D008875:Middle Aged; D010019:Osteomyelitis / Q000453:epidemiology / Q000628:therapy*; D012189:Retrospective Studies; D012307:Risk Factors; D013122:Spinal Diseases / Q000453:epidemiology / Q000382:microbiology / Q000628:therapy*; D013203:Staphylococcal Infections / Q000453:epidemiology / Q000628:therapy*; D016896:Treatment Outcome