Heterotopic Ossification
Heterotopic Ossification
In Spinal Cord Injury Patients
By
Anitia Gram
Heterotopic Ossification (HO) in spinal cord injury patients is a common complication seen a few weeks to months following injury. This paper will focus on R.B. A C2 ASIA A quadriplegic patient and his course of treatment for early HO that was detected in his right hip approximately 1 month following his accident. Heterotopic ossification is the presence of bone in the soft tissue where bone does not normally exist. The ossification process involves the formation of mature lamellar bone, which is indistinguishable from normal bone, in soft tissues surrounding paralyzed joints (Kedlaya, Sheridan 2013) The signs and symptoms are harder to diagnose in a patient that cannot tell you that they have a fever or feel pain. Classic signs are fever, swelling, erythema, and joint tenderness. R.B. is a 36 year old male who dove off the back of a boat into shallow water and sustained a cervical burst fracture of the 4-5 vertebrae. He had congenital narrowing of the spinal canal which made his injury more devastating because as his spinal cord swelled after the accident it ascended up the spinal cord leaving him unable to feel or move below the level of C2 and unable to breathe on his own. Once the R.B. was stable enough he was transferred to a rehabilitation hospital that specialized in spinal cord injuries. The first indication noted on the nursing assessment that R.B. may have H.O. was a fever and chills. There was no swelling of the right leg or hip area and he could not tell us if he was having pain in that area. We also looked at his lab values for alkaline phosphatase which were elevated. We next sent him out for a bone scan. A 3-phase, radionuclide bone scan using technetium-99m methylene diphosphonate remains the criterion standard for detecting early heterotopic ossification. The examination consists of a radionuclide angiogram followed by a blood pool image over the suggestive site. A
In Spinal Cord Injury Patients
By
Anitia Gram
Heterotopic Ossification (HO) in spinal cord injury patients is a common complication seen a few weeks to months following injury. This paper will focus on R.B. A C2 ASIA A quadriplegic patient and his course of treatment for early HO that was detected in his right hip approximately 1 month following his accident. Heterotopic ossification is the presence of bone in the soft tissue where bone does not normally exist. The ossification process involves the formation of mature lamellar bone, which is indistinguishable from normal bone, in soft tissues surrounding paralyzed joints (Kedlaya, Sheridan 2013) The signs and symptoms are harder to diagnose in a patient that cannot tell you that they have a fever or feel pain. Classic signs are fever, swelling, erythema, and joint tenderness. R.B. is a 36 year old male who dove off the back of a boat into shallow water and sustained a cervical burst fracture of the 4-5 vertebrae. He had congenital narrowing of the spinal canal which made his injury more devastating because as his spinal cord swelled after the accident it ascended up the spinal cord leaving him unable to feel or move below the level of C2 and unable to breathe on his own. Once the R.B. was stable enough he was transferred to a rehabilitation hospital that specialized in spinal cord injuries. The first indication noted on the nursing assessment that R.B. may have H.O. was a fever and chills. There was no swelling of the right leg or hip area and he could not tell us if he was having pain in that area. We also looked at his lab values for alkaline phosphatase which were elevated. We next sent him out for a bone scan. A 3-phase, radionuclide bone scan using technetium-99m methylene diphosphonate remains the criterion standard for detecting early heterotopic ossification. The examination consists of a radionuclide angiogram followed by a blood pool image over the suggestive site. A