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Study design: A randomized, prospective, double-blind, placebo-controlled clinical trial. Objectives: To determine the e ect of indomethacin on the prevention of heterotopic ossi®cation (HO) following spinal cord injury (SCI). Setting: County Hospital, Miami, Florida, USA. Methods: Sixteen patients were treated with slow-release indomethacin 75 mg daily and 17 patients received placebo for a period of 3 weeks. Prevention was started 21+14 days after SCI. In both groups of patients there was similar age of the patients as well as the level of SCI and ASIA impairment scale. Two methods were used to diagnose HO, bone scintigraphy and radiographic examination. Bone scintigraphy with technetium labeled methylenediphosphonate was used for diagnosis of early stage, while radiography was used for diagnosis of late stage of HO development. Results: A signi®cantly lower incidence of early HO was found in the indomethacin group (25%) than in the placebo group (65%; P50.001). Similarly there was a signi®cant reduction of late HO in the indomethacin group (12.5%) as compared to the placebo group (41%; P50.001). Conclusion: Our data suggest that indomethacin used during the ®rst 2 months after SCI is e ective in prevention of HO in a signi®cant number of patients.

Study design: A randomized, prospective, double-blind, placebo-controlled clinical trial. Objectives: To determine the effect of COX-2-selective inhibitor on the prevention of heterotopic ossification (HO) after spinal cord injury (SCI). Setting: County and University Teaching Hospital, Miami, FL, USA. Methods: A total of 76 patients were enrolled in the study. Among them, 39 patients received placebo, and 37 received COX-2-selective inhibitor rofecoxib 25 mg daily for a period of 4 weeks. Prevention was started 3 weeks after spinal cord injury (SCI). In both groups of patients there was similar age as well as the level of SCI and ASIA impairment scale. Two methods were used to diagnose early HO, clinical symptoms and bone scintigraphy. Radiography was used for diagnosis of late stages of HO development. Results: A significantly lower incidence of HO was found in the rofecoxib group (13.4%) than in the placebo group (33.3%: Po0.05). In patients receiving rofecoxib, there was a 2.5 times lower relative risk of developing HO than in the placebo group (95% CI, 2.3-6). There were no patients who discontinued the study due to adverse effects of medication. Conclusion: Our data suggest that COX-2-selective inhibitor rofecoxib is an effective medication in prevention of HO after SCI.

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Summ aryTwo groups of patients who developed orthostatic hypotension (OH) after spinal cord injury (SCI) were studied. In the first group all patients (4 females and 6 males) were asymptomatic, whereas in the second group (1 female and 9 males) all had clinical manifestations of hypotension. All but 3 patients were tetraplegic , and these patients were paraplegic above the T6 level. For this study blood pressure (BP) , heart rate and cerebral blood flow (CBF) velocity were measured simultaneously on a tilt table at 0, 30 , 60, and 80 degrees. Cerebral blood flow in the middle cerebral artery was measured bilaterally utilising the transcranial Doppler technique. In asymptomatic patients the mean baseline (0 degrees) BP (110 ± 16/70 ± 77 mm Hg systolic/diastolic) was not significantly different from the BP (106 ± 16/68 ± 11 mm Hg) of symptomatic patients. The mean maximal change in BP during tilling in the asymptomatic group ( -23 ± 10/10 ± 7 mm Hg) was also not significantly different when compared to the symptomatic group (-29 ± 13/11 ± 6 mm Hg). CBF in the symptomatic group during the hypotensive reaction at 80 degrees was 32.5 ± 5 cm/sec, while at the same body position in the asymptomatic group it was 40·9 ± 8 cm/sec (significant at the p < 0·02). In addition, CBF decreased in the symptomatic group at 80 degrees to 55·5 ± 9·6% of baseline, while in the asymptomatic group the fall was 69·3 ± 7·2% (p < 0·001). Our data suggests that autoregulation of CBF rather than systemic BP plays a dominant role in the adaptation to OH in patients with SCI.

Design: Retrospective analysis of medical records.Background/Objectives: To determine frequency and degree of hypothermic episodes in patients with chronic spinal cord injury (SCI).

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