Neuromuscular electrical stimulation and testosterone did not influence heterotopic ossification size after spinal cord injury: A case series

World J Clin Cases, 2016 · DOI: 10.12998/wjcc.v4.i7.172 · Published: July 16, 2016

Spinal Cord Injury Rehabilitation Musculoskeletal Medicine

Simple Explanation

This report presents the results of two men with chronic traumatic motor complete SCI who also had pre-existing HO and participated in a study investigating the effects of TRT or TRT plus NMES resistance training (RT) on body composition. Both the TRT and NMES + TRT protocols evoked muscle hypertrophy without stimulating the growth of pre-existing HO. The current two case reports demonstrated that TRT with or without NMES applications for 16 wk are considered safe rehabilitation strategies in persons with SCI who have HO formation.

Study Duration

16 wk

Participants

Two men with chronic traumatic motor complete SCI

Evidence Level

Level 4, Case Series

Key Findings

1
In Subject A (NMES-RT + TRT), the whole thigh skeletal muscle CSA increased by 10%, the knee extensor CSA increased by 17%, and the HO + femoral bone CSA did not change.
2
In Subject B (TRT), the whole thigh skeletal muscle CSA increased by 13% in the right thigh and 6% in the left thigh.
3
The femoral bone and HO CSAs in both thighs did not change.

Research Summary

Neuromuscular electrical stimulation (NMES) and testosterone replacement therapy (TRT) are effective rehabilitation strategies to attenuate muscle atrophy and evoke hypertrophy in persons with spinal cord injury (SCI). The purpose of this report was to determine if the anabolic effects of TRT with or without NMES-RT would trigger the growth of pre-existing HO in two persons with motor complete SCI. The results clearly demonstrate that TRT with or without NMES-RT did not impact the size of HO, suggesting that both interventions are safe in persons with motor complete SCI.

Practical Implications

Safe Rehabilitation Strategy

TRT with or without NMES-RT is a safe rehabilitation strategy for SCI patients with pre-existing HO.

Muscle Hypertrophy

Both TRT and NMES-RT can effectively stimulate muscle hypertrophy without exacerbating HO.

HO Monitoring

Patients with pre-existing HO should be identified and monitored in clinical trials involving anabolic interventions.

Study Limitations

1
Small sample size (two case reports)
2
Short trial duration (16 weeks)
3
Difficulty in separating HO region from the subperiosteal femoral bone in MRI analysis

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