Case Report
Copyright ©The Author(s) 2016. Published by Baishideng Publishing Group Inc. All rights reserved.
World J Clin Cases. Jul 16, 2016; 4(7): 172-176
Published online Jul 16, 2016. doi: 10.12998/wjcc.v4.i7.172
Neuromuscular electrical stimulation and testosterone did not influence heterotopic ossification size after spinal cord injury: A case series
Pamela D Moore, Ashraf S Gorgey, Rodney C Wade, Refka E Khalil, Timothy D Lavis, Rehan Khan, Robert A Adler
Pamela D Moore, Ashraf S Gorgey, Rodney C Wade, Refka E Khalil, Timothy D Lavis, Spinal Cord Injury Service and Disorders, Hunter Holmes McGuire VA Medical Center, Richmond, VA 23249, United States
Ashraf S Gorgey, Timothy D Lavis, Physical Medicine and Rehabilitation, Virginia Commonwealth University, Richmond, VA 23284, United States
Rehan Khan, Radiology Service, Hunter Holmes McGuire VA Medical Center, Richmond, VA 23249, United States
Robert A Adler, Endocrinology Service, Hunter Holmes McGuire VA Medical Center, Richmond, VA 23249, United States
Robert A Adler, Endocrine Division, Virginia Commonwealth University School of Medicine, Richmond, VA 23284, United States
Author contributions: All authors contributed to this paper.
Institutional review board statement: The study was approved by the local Institutional Review Boards of Hunter Holmes McGuire VA Medical Center and Virginia Commonwealth University.
Informed consent statement: Both participants enrolled in the study after reading and signing consent forms that were approved by local ethical committee.
Conflict-of-interest statement: None of the authors have any conflict of interest to disclose.
Open-Access: This article is an open-access article which was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution Non Commercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: http://creativecommons.org/licenses/by-nc/4.0/
Correspondence to: Ashraf S Gorgey, MPT, PhD, FACSM, Director of Spinal Cord Injury Research, Department of Veterans Affairs, Spinal Cord Injury Service and Disorders, Hunter Holmes McGuire VA Medical Center, 1201 Broad Rock Boulevard, Richmond, VA 23249, United States. ashraf.gorgey@va.gov
Telephone: +1-804-6755000-33386 Fax: +1-804-6755223
Received: March 2, 2016
Peer-review started: March 2, 2016
First decision: March 22, 2016
Revised: April 14, 2016
Accepted: May 7, 2016
Article in press: May 9, 2016
Published online: July 16, 2016
Processing time: 127 Days and 15.3 Hours
Abstract

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). However both interventions might increase heterotopic ossification (HO) size in SCI patients. We present 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. The 49-year-old male, Subject A, has unilateral HO in his right thigh. The 31-year-old male, Subject B, has bilateral HO in both thighs. Both participants wore transdermal testosterone patches (4-6 mg/d) daily for 16 wk. Subject A also underwent progressive NMES-RT twice weekly for 16 wk. Magnetic resonance imaging scans were acquired prior to and post intervention. Cross-sectional areas (CSA) of the whole thigh and knee extensor skeletal muscles, femoral bone, and HO were measured. 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. In Subject B (TRT), the whole thigh skeletal muscle CSA increased by 13% in the right thigh and 6% in the left thigh. The knee extensor CSA increased by 7% in the right thigh and did not change in the left thigh. The femoral bone and HO CSAs in both thighs did not change. Both the TRT and NMES-RT + TRT protocols evoked muscle hypertrophy without stimulating the growth of pre-existing HO.

Keywords: Heterotopic ossification; Neuromuscular electrical stimulation; Testosterone; Resistance training; Spinal cord injury

Core tip: Neuromuscular electrical stimulation (NMES) and testosterone replacement therapy (TRT) are effective rehabilitation strategies in restoring muscle size and lean mass in persons with spinal cord injury (SCI). However, the effects on ectopic bony growth similar to heterotopic ossification (HO) have yet to be determined. 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. Both the TRT and NMES + TRT protocols evoked muscle hypertrophy without stimulating the growth of pre-existing HO.