The role of hyperbaric oxygen treatment in the management of spondylodiscitis

Introduction: This study analysed treatment outcomes in a patient cohort diagnosed with spondylodiscitis, who received adjunct hyperbaric oxygen treatment (HBOT) in addition to antibiotic therapy at our clinic. Important considerations included the timing of HBOT initiation on treatment success, and recurrence rates. Methods: We retrospectively reviewed the records of all patients diagnosed with spondylodiscitis who received HBOT at the Underwater and Hyperbaric Medicine Clinic in Gulhane Training and Research Hospital, between 1 November 2016 and 25 October 2022. The patients received HBOT at 243.2 kPa for a total of 120 minutes per session, once daily for five days a week for a total of 30 sessions. Results: Twenty-five patients with spondylodiscitis were evaluated before and after combination HBOT and targeted antibiotic treatment. After treatment, patients had lower median (range) visual analogue pain scores (8 [4–10] vs 3 [0–7], P < 0.001) and C-reactive protein (22.3 [4.3–79.9] mg·L⁻¹ vs 6.8 [0.1–96.0] mg·L⁻¹, P = 0.002) and lower mean (standard deviation) white blood cell counts (8.8 [3.5] x 10⁹·L⁻¹ vs 6.1 [1.6] x 109·L⁻¹, P = 0.002). When patients were examined (median) 48 months (2–156 months) after the completion of treatment, there were no persistent cases of spondylodiscitis. Conclusions: Combination HBOT with targeted antibiotic therapy effectively managed our cohort of patients diagnosed with spondylodiscitis. Hyperbaric oxygen treatment was safe, with no complications experienced. Moreover, HBOT may have helped to eliminate persistence and recurrence of symptoms with long term follow-up. A randomised controlled study with a larger number of patients is needed for more definitive conclusions.