Session Title: Neurological Rehabilitation Case and Research Report
Session Time: 12:30pm-2:00pm
Location: Research Hub - Kiosk 5
Disclosures: Iain M. Bailey, MD: None: Other Financial or Material Support
Case Description: Oral etidronate has long been a mainstay of treatment for heterotopic ossification (HO) after spinal cord injury (SCI). Due to limited availability of etidronate (it is no longer being manufactured), one may question whether other bisphosphonates may be appropriate for treating HO. IV pamidronate has been cited in literature as being used peri- and postoperatively in individuals after HO excision in an effort to prevent recurrence but has not been studied in individuals not requiring surgical excision. We report on a patient with newly diagnosed left hip HO through plain radiography. Serum electrolytes and inflammatory markers were obtained prior to treatment. The patient underwent a 7-day continuous IV pamidronate infusion with stepwise taper. Oral indomethacin (75 mg daily) was concomitantly administered and to be continued for 6 months. Electrolytes were monitored throughout pamidronate infusion, and radiographs were monitored monthly for 6 months post-treatment initiation.
Setting: Inpatient Spinal Cord Injury Rehabilitation Unit
Patient: 60-year-old male with C1 AIS C spinal cord injury and symptomatic heterotopic ossification of the left hip.
Assessment/Results: The patient experienced significant improvements in pain, swelling, spasticity, and hip ROM with treatment. Ionized Ca decreased minimally and was mitigated by oral supplementation. Initial follow-up radiograph showed stable HO. The patient was discharged and is to be followed as an outpatient to monitor symptoms, laboratory studies, and radiographic findings. Another patient with SCI and hip HO was also initiated on this protocol shortly afterward.
Discussion: Concomitant use of indomethacin and IV pamidronate in this patient resulted in rapid symptomatic relief, and radiographic findings remained stable.
Conclusion: Treatment of HO with IV pamidronate and indomethacin may be appropriate, and further studies are warranted given the limited availability of etidronate.
Level of Evidence: Level V
To cite this abstract in AMA style:Bailey IM, Chay W, Lin J. Intravenous Pamidronate for the Treatment of Heterotopic Ossification (HO) of the Hip in a Patient with Subacute Spinal Cord Injury: A Case Report [abstract]. PM R. 2019; 11(S2)(suppl 2). https://pmrjabstracts.org/abstract/intravenous-pamidronate-for-the-treatment-of-heterotopic-ossification-ho-of-the-hip-in-a-patient-with-subacute-spinal-cord-injury-a-case-report/. Accessed September 24, 2023.
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PM&R Meeting Abstracts - https://pmrjabstracts.org/abstract/intravenous-pamidronate-for-the-treatment-of-heterotopic-ossification-ho-of-the-hip-in-a-patient-with-subacute-spinal-cord-injury-a-case-report/