EVALUATION AND MANAGEMENT OF HETEROTOPIC OSSIFICATION IN PATIENTS WITH SPINAL-CORD INJURY

Sixty-three patients with paralysis secondary to spinal cord injury (S CI) were screened for heterotopic ossification (HO) by bone scintigrap hy 27 +/- 14 (mean +/- SD) days after SCI. There were four female and 59 male patients, 36 had paraplegia and 27 tetraplegia. The age of pat ients was 28 +/- 9 years. Bone scintigraphy was obtained with a 3-phas e test using 99m-technetium labeled diphosphonate, and the positive th ird phase was used as a criterion for diagnosis of HO. Bone scintigrap hy was negative for HO in 27 patients (14 tetraplegic and 13 paraplegi c) and positive in 36 patients (13 tetraplegic and 23 paraplegic). The patients with positive HO were treated with etidronate, first with an intravenous dose of 300 mg/day for 3 days, and then with an oral dose of 20 mg/kg/day for 6 months. The follow-up of patients consisted of clinical and radiographic evaluations every 2-4 months. The extent of HO was classified radiographically. In the treated group of patients w ho completed the entire course of etidronate therapy one patient devel oped HO, the remaining 28 (97%) patients had no radiographic evidence of HO during the follow-up of 10.6 +/- 4.5 months after initiation of therapy.