Polyarticular Neurogenic Heterotopic Ossification in a Spinal Cord Injury: A Case Report from Saudi Arabia

Abstract

A 33-year-old male victim of a motor vehicle accident, who presented with a T12 (thoracic 12 vertebra) burst fracture (ISNCSCI T11 AIS-A: International Standards for Neurological Classification of Spinal Cord Injury T11 ASIA Impairment Scale), was admitted to a rehabilitation hospital. A stage-II left ischial pressure ulcer was also reported. An X-ray of the pelvis revealed bilateral neurogenic heterotopic ossification (NHO) in both hips and knees, which was further confirmed by TC-99m methylene diphosphonate (MDP) bone scintigraphy. Interventions included indomethacin and conservative management. Surgery was not preferred, as NHO was still immature. Moreover, patient transfer and lower body dressing were unaffected by NHO. It is important to consider an early radiological screen in selected high-risk cases for NHO, to minimize the risk of associated complications.

Neurogenic Heterotopic Ossification of the Hip after Brain Injury. Function Recovery Preserving Hip Joint: A Case Report

“…Patients most commonly present with various grade of sensitive or motor deficit. In those cases, treatment aims to improve quality of life avoiding patients’ bedding and related complications (e.g., decubit ulcers, infections, or deep vein thrombosis) [ 6 ]. Our patient had completely restored his functions after 5 months of rehabilitation and did not present residual neurological deficits at the time of surgery.…”

“…Although proper pathogenetic mechanism is unclear, prolonged coma, tissue hypoxia, mechanical ventilation, spasticity and lack of extremity movements have been supposed as possible trigger of the disease [ 4 , 5 ]. Proximal and grater joints are most commonly affected, with the hip accounting for about half of the cases [ 6 ]. Patients develop restriction in joint range of motion (ROM), besides various grade of neurological sequelae.…”