Heterotopic Ossification in Paraplegia

This paper is based on study over twelve and a half years of 170 patients suffering from traumatic paraplegia or tetraplegia, ofwhom 162 survived for more than a month after injury, and of 103 patients with other lesions of the spinal cord. The patients in the second group were less suitable for analysis because in many the lesions were disseminated or incomplete: few could be compared with the patients with traumatic paraplegia, who generally had transverse and complete lesions with a well defined neurological level. Heterotopic ossification was found in forty-seven patients with traumatic paraplegia and twenty-five with non-traumatic lesions. HISTORY Towards the end of the first world war D#{233}jerineand Ceillier presented to the Soci#{233}t#{233} de Neurologie in Paris a series of cases of heterotopic ossification in paraplegia, and published a comprehensive paper (1918c) containing a clinical and radiological study ofthe condition as observed at the Institution Nationale des Invalides. The following year D#{233}jerine, Ceillier and D#{233}jerine (1919) presented a paper on the anatomical and histological aspects of the disease, presenting sixteen anatomical specimens and a number of histological slides and colour photographs obtained from eleven patients. Little was known about the condition before these studies. After a prolonged search of the French literature for previously published cases of arthropathy ill paraplegia, they were able to find only one unequivocal example (Chipault 1900). Geldmacher (1925) was unable to find records of more than four examples in the German literature (Riedel 1883, Israel 1920). In the following years the condition was noted by other authors in traumatic and nontraumatic lesions ofthe central nervous system but was usually referred to as myositis ossificans. Geldmacher (1925) proposed the name ostiasis neurotica para-articularis or paraossalis. Soule ( I 945) called the condition neurogenic ossifying fibromyopathy. Nevertheless the term ectopic bone or heterotopic ossification seems the most appropriate designation because it covers bone formed in muscle and in other soft tissues, whether of inflammatory or non-inflammatory origin. MORBID ANATOMY