ABSTRACT
STUDY DESIGN: This was a blind, prospective study of the effect of sera from patients with spinal cord and head injuries on osteoblast proliferation. OBJECTIVES: The authors studied whether a humoral factor that stimulates the formation of heterotopic bone is released into the circulation after a neural injury. BACKGROUND DATA: Other authors have shown that a humoral osteoinductive factor may be released after head and spinal cord injuries. METHODS: Serum was obtained at certain times throughout the first 12 weeks post-injury and from control subjects. It was incubated with osteoblasts harvested from fetal rats, as well as with fibroblast controls. RESULTS: There was a significant rise in serum mitogenic activity after injury in both groups. When patients that developed heterotopic ossification were compared to other patients and controls, no significant differences were seen. CONCLUSIONS: This in vitro study fails to support a humoral mechanism for heterotopic ossification after spinal cord or brain injuries.
Subject(s)
Brain Injuries/blood , Glycoproteins/blood , Growth Substances/blood , Ossification, Heterotopic/etiology , Osteoblasts/cytology , Spinal Cord Injuries/blood , Adult , Animals , Brain Injuries/complications , Cells, Cultured , Female , Fibroblasts/cytology , Glycoproteins/isolation & purification , Growth Substances/isolation & purification , Humans , In Vitro Techniques , Intercellular Signaling Peptides and Proteins , Male , Mitosis , Rats , Spinal Cord Injuries/complicationsABSTRACT
Eighteen neurologically intact patients with burst fractures at the thoracolumbar junction were treated with early ambulation in a total contact orthosis. No attempt was made to reduce the associated deformity. Selection criteria excluded patients with posterior column disruption. Hospital stay averaged 10 days. Follow-up averaged 19 months. Mean kyphosis was 19 at time of injury and 20 at follow-up. At follow-up, 15 patients rated their pain as little or none. Seventeen patients had little or no restriction of activity. Follow-up computed tomography (CT) scans obtained in eight patients showed significant resorption of retropulsed bone. No deterioration of neurologic function developed in any patient. In patients with intact posterior elements and thoracolumbar burst fractures, early mobilization in a total contact TLSO can lead to satisfactory functional results. Prolonged bed rest was not required in this series. The authors attribute the good results of nonoperative management to the exclusion of patients with posterior column disruption.