Multifocal Osteonecrosis in Spinal Cord Injury

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Multifocal osteonecrosis, Spinal cord injury


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.


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Matthews AH, Davis DD, Fish MJ, Stitson D (2024) Avascular Necrosis. StatPearls. StatPearls Publishing Copyright © 2024, StatPearls Publishing LLC., Treasure Island (FL)

Goodman SB (2020) Osteonecrosis: Overview of New Paradigms in the Etiology and Treatment. Instr Course Lect 69:103-110

Gallart Ubeda V, Elia Martinez JM, Puerta de Diego R, Elia Martinez I, Valero Inigo JC (2020) [Multiple osteonecrosis. Update and case report]. Rehabilitacion (Madr) 54:63-67.

Fehlings MG, Tetreault LA, Wilson JR, Kwon BK, Burns AS, Martin AR, Hawryluk G, Harrop JS (2017) A Clinical Practice Guideline for the Management of Acute Spinal Cord Injury: Introduction, Rationale, and Scope. Global Spine J 7:84S-94S.

Osebold WR, Kody MH (1994) Bilateral humeral head osteonecrosis following spinal cord injury: a case report illustrating the importance of adhering to the recommendations of the Second National Acute Spinal Cord Injury Study. Iowa Orthop J 14:120-124

Rafael BG, Lackner H, Engler GL. Disseminated Intravascular Coagulation during Surgery for Scoliosis. Clin. Orthop. 162:41-46, 1982.

Shah KN, Racine J, Jones LC, Aaron RK (2015) Pathophysiology and risk factors for osteonecrosis. Curr Rev Musculoskelet Med 8:201-209.

van Kuijk AA, van Kuppevelt HJ, van der Schaaf DB (2000) Osteonecrosis after treatment for heterotopic ossification in spinal cord injury with the combination of surgery, irradiation, and an NSAID. Spinal Cord 38:319-324.




How to Cite

Tıkız, C., Özbek, İlhan C., & Onağ, E. (2024). Multifocal Osteonecrosis in Spinal Cord Injury. European Journal of Therapeutics, 30(3), 382–385.



Letter to the Editor