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

Cureus, 2019 · DOI: 10.7759/cureus.4019 · Published: February 5, 2019

Simple Explanation

Spinal cord injury (SCI) can lead to various complications, including neurogenic heterotopic ossification (NHO), where bone forms in soft tissues around joints. This case report describes a patient with a T12 burst fracture who developed NHO in both hips and knees, which is a rare occurrence. Early radiological screening is important for high-risk cases to minimize complications associated with NHO.

Study Duration

Not specified

Participants

A 33-year-old male

Evidence Level

Case Report

Key Findings

1
A 33-year-old male with a T12 burst fracture developed bilateral neurogenic heterotopic ossification (NHO) in both hips and knees.
2
TC-99m methylene diphosphonate (MDP) bone scintigraphy confirmed the presence of immature NHO around both knees and hip joints bilaterally.
3
Conservative management with indomethacin was chosen as the NHO was not significantly affecting the patient's daily activities, and surgery was not preferred due to the immature nature of the NHO.

Research Summary

This case report presents a rare instance of polyarticular neurogenic heterotopic ossification (NHO) affecting both hips and knees in a patient with a spinal cord injury (SCI). The patient, a 33-year-old male, sustained a T12 burst fracture and subsequently developed bilateral NHO, confirmed by radiological imaging. The case highlights the importance of early radiological screening in high-risk SCI patients to facilitate timely diagnosis and management of NHO, although treatment consensus is lacking.

Practical Implications

Early Detection

Early radiological screening in high-risk SCI patients can help in timely diagnosis of NHO.

Conservative Management

Conservative management, including NSAIDs like indomethacin, may be appropriate for immature NHO that does not significantly affect daily activities.

Further Research

Further research is needed to establish consensus on treatment modalities for NHO, especially in rare polyarticular cases.

Study Limitations

1
The exact pathophysiology of NHO is still not clear.
2
NHO in the bilateral hip joints and bilateral knee joints associated with SCI has never been reported previously and its pathogenesis is also unknown.
3
lack of consensus on treatment modalities

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