A patient with complete tetraplegia feels
pain on his hip joint.
Before that time, he couldn’t feel any
sense below neck area.
What happened? Does the spinal cord
recover?
If a patient with spinal cord injury feels
sudden pain on his/her hip joint area, we have to consider about heterotopic
ossification. Heterotopic ossification (HO) is a common complication occurring after
traumatic brain injury, and spinal cord injury. HO has been reported to occur
in 20-30% of persons with SCI.
Why does HO occur? It is poorly understood
yet. Just we suggest that CNS processes facilitate HO bone formation. Bone
remodeling is subject to central control through the sympathetic nervous system.
Pluripotential mesenchymal cells in soft tissues differentiate into oeteoblasts
and other cell lines involved with bone formation.
Plain radiography or CT scan can be helpful
to evaluate HO. However, the definitive diagnostic test is a bone scan. It show
HO 7-10 days earlier than a plain x-ray.
If detected, treatment of established HO
should begin promptly. It is aimed at halting the ossification process.
Intravenous etidronate, 300mg/day, followed by oral etidronate, 20mg/kg/d for 6
months, has been shown to be effective. However, there is no evidence that 6
months of treatment with etidronate is more effective than 3 months. Radiation
therapy or surgical resection of HO can be done. Surgical resection is done only
to restore joint motion and functional skills.
Pain control is also an important issue. Because,
most patients with SCI already take some pain killer, just NSAIDs or acetaminophen
are not useful for pain management. One of my patient who has taken Oxycodone
twice a day, can relieve his pain after applying Fentanyl patch.
Gentle ROM exercise is also important
physical therapy. It prevents restriction of joint ROM. I want to emphasize the
word ‘gentle’. Because aggressive ROM exercise can make hematoma or soft tissue
injury, so that HO can become aggravated
댓글 없음:
댓글 쓰기