E • COMPLICATIONS
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those of these authors (Table 4). The serum alkaline phosphatase showed marginal
values in 3 cases and only in 3 cases raised values.
Various factors may accelerate the development and increase the intensity of osteo-
porosis. Infections and toxaemia resulting from pressure sores, pyelonephritis and renal
deficiency are the most important factors. Plaster casts and, in particular, plaster beds
play a great role in this process of decomposition. How far hormonal factors or lack of
nutritional components to the matrix as a result of disturbances of blood circulation
following cord injuries play a role in this process still needs clarification. In particular,
the question may be raised whether or not the slowing down of the blood circulation
as a result of the paralytic vasodilatation caused by the interruption of the vasoconstric
tors in complete transverse lesions of the cord may promote or accelerate this process of
demineralization.
Although osteoporosis may develop in all skeletal parts below the cord transection,
as a rule the parts most afflicted are the pelvis, the upper third and the supracondylar
region of the femur. The osteoporotic bone with its rarefied spongiosa becomes easily
FIG. loib.
