Myositis Ossificans Circumscripta in Para-/Tetraplegics

Abstract

At the Hospital of Physical Medicine, Hornbaek, we analysed in retrospect 52 cases of myositis ossificans circumscripta (MOC) among 605 patients with para/tetraplegia. MOC proved significantly more common after total than after subtotal spinal cord injuries. MOC was not observed in any case above the motor level of the spinal cord lesion. This neurological relationship appears to "explain" the finding that MOC is more common in para/tetraplegia of traumatic origin (more complete spinal cord lesions) than among those caused by slipped discs or tumours. Twenty-five per cent of the patients ended up with fairly mild and 12% with more severe hip contractures, the latter causing recurrent, contralateral decubital ulcers over the ischial tuberosity and protracted hospitalization. To aid diagnosis, the authors suggest a simple programme for all para/tetraplegics. In our opinion, routine X-ray examination is not necessary. Intensified research into the causative factors and treatment is needed, not only to facilitate these patients' social adaptation, but also for socio-economic reasons.

Neurogenic heterotopic ossification in spinal cord injury

“…In general, no association was found between NHO and race or gender, 13,19 although in some studies a slightly Figure 1 Visual approach to the pathophysiology of NHO in SCI patients. OAC: oral anti-coagulant.…”

“…Although Catz et al 37 did not ®nd a relationship between radiologically diagnosed NHO and the severity of the motor de®cits, other authors have reported that complete transverse SCI is more commonly associated with NHO than incomplete SCI with relative risks (RR) reported between 2.0 ± 4.2. 1,13,14,19,21,22,24,88 Also, NHO is less frequently reported (55%) in patients with lumbosacral or conus-cauda lesions, which regain or retain ambulation. 88 Other clinical factors associated with NHO are the presence of pressure sores, 6,21,22,24,30,47 urinary tract infections or renal stones, 3,4,6,24,100 deep venous thrombosis (DVT), 24 severe spasticity, 22 and (micro) trauma.…”

“…70,129,137 In several studies radiographic signs of NHO were found on average 1 ± 10 weeks after the ®rst clinical signs. 19,36,47 Plain radiography may be positive even in asymptomatic patients as early as 4.5 weeks after the SCI. For monitoring NHO activity, plain radiography may be valuable as long as the X-rays show modi®cation from one examination to the next.…”

“…This insight takes into account the highly`vascular' state of the paralysed area and the concomitant use of anticoagulants (to prevent DVT), that may predispose to haematoma and secondary NHO, particularly during the rehabilitation phase after SCI. 19 Various, more speci®c prophylactic measures have been proposed to prevent NHO, including the use of diphosphonates, NSAID, and more recently irradiation. The latter two methods have been successful to some degree in preventing heterotopic ossi®cation eg after THA, 142,152,153,160 ± 163,180 but no controlled studies are available in SCI patients.…”

“…In nontraumatic myelopathies the incidence of NHO seems less compared to traumatic SCI ranging somewhere between 6 ± 15%. 6,14,19,29,30 NHO is less common in children than in adults with an incidence generally reported between 3 ± 10%. 31,32 The clinical symptoms in children do not di er from those reported in adults, but are less pronounced compared to adult patients.…”