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Final Program


Final Program

1237 - Heterotopic Ossification in Spinal Cord Injury With a Normal Alkaline Phosphatase in the Setting of an Inpatient SCI Rehabilitation : A Case Report

Thursday, February 27, 2025
5:00 PM - 6:30 PM MST

    Presenting Author(s)

  • IN

    Isabel Nip, MD, MS

    Physical Medicine & Rehabilitation Resident
    UConn Health/Hartford Hospital/Gaylord Specialty Healthcare
    West Hartford, Connecticut, United States

    • Co-Author(s)

  • DR

    David Rosenblum, MD

    Medical Director, Milne Institute
    Gaylord Hospital
    Wallingford, Connecticut, United States

Case Diagnosis: Heterotopic Ossification

Case Description: 24-year-old male with no significant past medical history sustained a fall off a ladder resulting in T4 complete paraplegia. 2.5 months post-injury, the patient developed decreased right hip external rotation with no fever, erythema, warmth, or pain.  Alkaline phosphatase was normal and remained so over 2 months post injury, while creatine kinase, erythrocyte sedimentation rate (ESR), and C-reactive protein (CRP) were all elevated.  X-ray of the right hip demonstrated soft tissue ossification adjacent to the right femoral intertrochanteric region consistent with early heterotopic ossification (HO).

Discussions:

HO, the pathological formation of extraskeletal bone in soft tissue, commonly affects SCI patients with most cases occurring in the hips. While not sensitive or specific, several laboratory studies may be considered in the diagnosis of HO, including creatine kinase, ESR, CRP, and the most commonly ordered alkaline phosphatase (ALP).  Limited research exists on ALP levels in HO in SCI.  In this case, ALP remained normal initially as well as beyond 10 weeks.  HO was diagnosed despite normal levels of ALP, which led to changes in the plan of care.  While triple-phase bone scans are more sensitive for early diagnosis than radiographs for HO, radiographs are specific and can diagnose HO despite normal ALP, supported by other laboratory abnormalities. SCI patients benefit from a low threshold for considering HO despite normal serum ALP levels.  The etiology, epidemiology, pathophysiology, diagnostic evaluation, prevention, and treatment options in SCI are reviewed.

Conclusions: ALP is nonspecific and may not be a reliable screening method for HO detection in SCI.