1000 Section - Focal Shockwave Therapy for Paravertebral Heterotopic Ossification: A Case Report

Case Diagnosis: Paravertebral Heterotopic Ossification in a Tetraplegic Patient

Case Description: A 36-year-old male with traumatic cervical SCI (AIS C) developed severe chronic axial burning pain (VAS 10/10) associated with extensive dorsolumbar paravertebral HO on imaging. He had a prior history of bilateral hip HO surgically treated. Due to persistent, function-limiting pain, focal piezoelectric shockwave therapy was initiated. Three sessions were performed without complications, using the following protocol:
• 2000 pulses at 2 cm depth, intensity 20, 8 Hz, left paravertebral region at L1
• 2000 pulses at 2 cm depth, intensity 20, 8 Hz, right paravertebral region at L1
• 2000 pulses at 5 cm depth, intensity 20, 8 Hz, central L1 region
• 1000 pulses at 0–1 cm depth, intensity 10, diffuse dorsal application

Discussions: Paravertebral heterotopic ossification (HO) is an uncommon but disabling complication in patients with spinal cord injury (SCI), often resulting in severe axial pain and functional impairment. Conventional treatments include NSAIDs, physical therapy, radiotherapy, and surgery, yet many individuals experience persistent symptoms. Shockwave therapy has emerged as a potential adjunct treatment for pain modulation and tissue remodeling, although evidence regarding its use in paravertebral HO remains limited.

Conclusions:

Focal shockwave therapy provided significant analgesic benefit in this case of dorsolumbar paravertebral HO with refractory pain. The technique appears to be a promising, non-invasive adjunct for managing HO-related pain. Further studies are warranted to establish standardized protocols and assess functional and radiological outcomes.