Multifocal Osteonecrosis in Spinal Cord Injury

Abstract

Dear Editors,

Necrosis of the bone marrow and trabecular portion as a result of limited blood flow is known as osteonecrosis (ON) [1]. Several causes have been proposed for the development of ON, including vascular occlusions, ischemia, intravascular coagulation in interosseous tissue, increased intracortical pressure, mechanical stress, precursor cell death, and suppression of angiogenesis. There are multiple risk factors and medical condition associated with ON, including infections, hematological and coagulation problems, connective tissue illnesses, kidney diseases, excessive alcohol and tobacco use, and the use of corticosteroids and cytotoxic drugs [2].

Multifocal osteonecrosis, defined as the presence of osteonecrosis in three or more bone sites, is a rare entity representing less than 3% of osteonecrosis patients [3].

Due to its potent anti-inflammatory properties, methyl prednisolone (MP), one of the most extensively used corticosteroids, has been used for a long time in the acute phase of spinal cord injury and brain edema due to its strong anti-inflammatory properties [4]. Although studies have reported cases of multifocal osteonecrosis (MFON) brought on by corticosteroid medication, this link has never been examined in a patient with a spinal cord injury.

This letter aims to highlight MFON that occurred in a patient who underwent acute spinal cord injury and high-dose steroid therapy.