Background & Aims

Heterotopic ossification is the abnormal formation of bone in soft tissues, usually caused by trauma, neurological injury or burns. It often occurs around large joints such as hips, knees and elbows, causing variable degrees of dysfunction and pain. Patients with spinal cord injury are prone to heterotopic ossification, as well as osteoporosis and fractures due to disuse. This study aims to report a case of heterotopic ossification and osteoporotic fractures in a female patient with spinal cord injury, and to review the current literature on the diagnosis, prevention and treatment of these complications.

Methods

The reported information was obtained through medical record review, patient interview, imaging exam record and literature review.

Results

Female patient, 62 years old, paraplegic for 2 years at T4 level due to spinal cord infarction. She had exams showing osteoporosis, a diagnosis already present before paraplegia. Radiographs showed bilateral heterotopic ossification around the hips, associated with bilateral non-consolidated intertrochanteric fractures. The patient denied history of trauma, suggesting that the fractures occurred during manipulations. Conservative treatment of the fractures was chosen, since the patient had good range of motion of the hips and good pain control. For the control of heterotopic ossification, zoledronic acid was used.

Conclusions

Patients with spinal cord injury are prone to develop osteoporosis and heterotopic ossification, which are common complications that can cause further morbidity if not assessed early. Osteoporosis tends to occur soon and severely after the injury, and may lead to fragility fractures, especially in lower limbs. The optimal treatment for these fractures is unclear, and they were traditionally managed conservatively due to the low demand of the patients. As for heterotopic ossification, its prevention can be achieved with the use of non-steroidal anti-inflammatory drugs, and there is some evidence that radiotherapy and bisphosphonates can help control it and prevent its progression. The definitive treatment, however, is usually surgical, and should be tailored to the individual needs and complaints of the patient.

References

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Presenting Author

Lucio Gusmao Rocha

Poster Authors

Victor Giacomini

MD

Centro Avançado de Dor e Especialidades Médicas - Distrito Federal

Lead Author

E-mail

Luisa Mesquita de Morais

MD

Centro Avançado de Dor e Especialidades Médicas - Distrito Federal

Lead Author

E-mail

Victor Queiroz Giacomini

MD

Centro Avançado de Dor e Especialidades Médicas - Distrito Federal

Lead Author

E-mail

Rafael Vieira Rocha

MD

Centro Avançado de Dor e Especialidades Médicas - Distrito Federal

Lead Author

E-mail

Gulliver Rezende Teodoro Ribeiro

MD

Centro Avançado de Dor e Especialidades Médicas - Distrito Federal

Lead Author

E-mail

Robson Nunes da Silva

MD

Centro Avançado de Dor e Especialidades Médicas - Distrito Federal

Lead Author

E-mail

Pedro Vinicius Araújo de Abreu

Student/trainee

Escola Superior de Ciências da Saúde (ESCS) - Distrito Federal

Lead Author

E-mail

Frederico Barra de Moraes

MD

Centro Avançado de Dor e Especialidades Médicas - Distrito Federal

Lead Author

E-mail

Leandro Mamede Braun

Centro Avançado de Dor e Especialidades Médicas - Distrito Federal

Lead Author

E-mail

Frederico Barra de Moraes

MD

Universidade Federal de Goiás (UFG)

Lead Author

E-mail

Topics

  • Specific Pain Conditions/Pain in Specific Populations: Muscle and Myofascial pain