Predicting Factors For Development of Heterotopic Ossification in Spinal Cord Injury Patients

Heterotopic ossification (HO) is a frequent complication in spinal cord injury (SCI) that is often difficult to treat. the incidence ranges from 16-35%. Association of certain complications in spinal cord injury increases the incidence of HO. This is a cross-sectional study conducted at SVNIRTAR, Cuttack, Odisha from January 2009 to December 2014. Out of 132 SCI patients attended to OPD or admitted to SCI ward, HO at different site was diagnosed in 86 patients. A close observation was done on these patients with respect to their associated complications and their relation to development of HO is discussed. Authors’ affiliation: 1 MBBS, DNB(PMR),DNB (PMR), Asst Professor 2 MMPT, Senior PT cum junior lecturer 3 MBBS 4 MBBS, DNB (Ortho) 5 MS (Ortho),DNB(PMR), Associate Professor Physical Medicine and Rehabilitation Department, Swami Vivekananda National Institute of Rehabilitation Training and Research, Olatpur, Bairoi, Cuttack, Odisha Cite as: Pabitrakumar Sahoo, Mamatamanjari Sahu, D K Singh, S P Das. Predicting factors for development of heterotopic ossification in spinal cord injury patients. IJPMR, December 2015; Vol 26(4) :90-3 Correspondence: Dr Pabitrakumarsahoo, Asst professor (PMR), SVNIRTAR, Olatpur, Bairoi, Cuttack-754010, Odisha, India, E mail: pabitra2406@gmail.com Received on 05/11/2015, Accepted on, 15/12/2015 Key wards: Heterotopic ossification(HO), spinal cord injury (SCI), spasticity, pressure sore. Introduction: H ossification (HO) is the formation of true bone in ectopic sites often within the connective tissue of muscle surrounding peripheral joints in patients with neurologic disorders.. It is a frequent complication in spinal cord injury (SCI)patients where the incidence ranges from 16-35%. In non-traumatic myelopathies the incidence of HO seems less compared to traumatic SCI ranging somewhere between 6-15%. HO is less common in children than in adults with an incidence generally reported between 3and10%1,2. According to Chalmers etal3 three conditions must be met for the formation of ectopic ossification: the presence of osteogenic percursor cells, an inducing agent, and a permissive environment. Although the precise causal mechanism for HO is still unknown, humoral, neural and local factors probably all play a role in its pathophysiology . There is either a migration of distant mesenchymal cells to the area involved, with subsequent transformation of these cells into osteoblasts, or a transformation of the local mesenchymal cells directly into osteoblasts4-6. Whether these cells migrate at random or in response to some chemotactic factor is still not known, but the importance of several factors has been suggested in the transformation of mesenchymal cells into osteoblasts6. Microscopic study shows that it has four zones. 1. Innermost zone contains highly active zone with mitotic figures like malignant sacomatous cells. 2. Adjacent zone containing cells less active in appearance, but forming osteoid tissue. 3. Zone of trabecular organisation with osteoblasts and fibrous tissue. 4. Peripheral zone of fibrous tissue. The purpose of the study is to find out possible associated factors which can be considered as predictors of development of HO in SCI patients. The data are compared with data of published literature. Materials and Methods: This cross-sectional study was done during January 2009 to December 2014. All the patients attending OPD as OPD patient and patients admitted to SCI ward of SVNIRTAR, Olatpur, Cuttack were screened for HO. Patients were assessed clinically and radiologically.