Deep vein thrombosis of the common iliac vein caused by neurogenic heterotopic ossification in the anterior lower lumbar spine of a patient with complete paraplegia due to radiation-induced myelopathy

The Journal of Spinal Cord Medicine, 2022 · DOI: 10.1080/10790268.2020.1807767 · Published: March 1, 2022

Spinal Cord Injury Cardiovascular Science Musculoskeletal Medicine

Simple Explanation

This case report describes a rare instance of deep vein thrombosis (DVT) in a patient with paraplegia due to radiation-induced myelopathy. The DVT was caused by neurogenic heterotopic ossification (NHO) compressing the common iliac vein in the lower lumbar spine. This case highlights the importance of considering NHO in unusual locations as a potential cause of DVT in patients with spinal cord injuries.

Study Duration

Not specified

Participants

One 28-year-old male with complete paraplegia

Evidence Level

Case Report

Key Findings

1
DVT in the left common iliac vein (CIV) was observed in a patient with paraplegia.
2
The left CIV was significantly compressed by NHO at the anterior longitudinal ligament of the lumbar spine.
3
The lumbar spine NHO developed 1.5–2.5 years after the onset of paraplegia and had a longer maturation period than NHO at other sites.

Research Summary

This case report describes a patient with paraplegia following radiation-induced myelopathy who developed DVT in the left common iliac vein (CIV) due to compression by neurogenic heterotopic ossification (NHO) in the anterior lower lumbar spine. The NHO caused compression of the left CIV, leading to DVT, and was possibly influenced by May-Thurner syndrome and decreased vascular tone due to SCI. This case highlights a rare cause of DVT in SCI patients and suggests that NHO in unusual locations should be considered as a potential etiology.

Practical Implications

Diagnostic Awareness

Clinicians should consider NHO in atypical locations, such as the lumbar spine, when evaluating the cause of DVT in patients with spinal cord injuries.

Prolonged Monitoring

NHO in the lumbar spine may develop later and mature over a longer period compared to NHO in more common locations, necessitating prolonged monitoring in SCI patients.

Treatment Strategies

This case suggests that treatment strategies for DVT in SCI patients should consider the possibility of mechanical compression from NHO, potentially requiring surgical intervention or other interventions to address the compression.

Study Limitations

1
Single case report limits generalizability.
2
The exact mechanisms of NHO development and its relation to DVT are not fully understood.
3
Patient's specific history of radiation-induced myelopathy may limit applicability to other SCI etiologies.

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