PROSTAGLANDIN E-2 MEASUREMENTS - THEIR VALUE IN THE EARLY DIAGNOSIS OF HETEROTOPIC OSSIFICATION IN SPINAL-CORD INJURY PATIENTS

Objective: To look for a possible relation between the occurrence of h eterotopic ossification (HO) and the modifications of the 24-hour pros taglandin E-2 (PGE(2)) urinary excretion. Design: A 5-year prospective study to determine the 24-hour urinary excretion of PGE(2) by radioim munoassay with specific antisera not cross-reacting with TXA2, TXB2, 1 9-keto-PGE(2 alpha), PGI(2), 6-keto-PGF(1 alpha). Setting: The laborat ory of a division of endocrinology and diabetology of a university hos pital. Patients: Of 262 acute spinal cord injury patients screened, 44 were eligible for the study. Interventions: Serial diagnostic quantit ative bone scannings with technetium 99m Tc methylene diphosphate (Tc- 99m-MDP) and therapeutic assessment of radiotherapy and indomethacin, Mean Outcome Measure: Hypothetical increase of PGE(2) before and durin g HO formation. Results: Of 44 patients, 8 developed an HO (18.8%) wit h concomitant marked increase of the PGE(2) excretion for as long as t he HO had not reached maturity. The results of the radiotherapy were i nconclusive. Indomethacin was shown to be efficacious in holding back or slowing down the HO evolution, Conclusions: Measurement of the 24-h our PGE(2) urinary excretion appears to be a valuable indicator in the early diagnosis of HO, Indomethacin should be considered as an altern ative to other existing therapies. (C) 1997 by the American Congress o f Rehabilitation Medicine and the American Academy of Physical Medicin e and Rehabilitation.