Bilateral hip heterotopic ossification with sciatic nerve compression on a paediatric patient–An individualized surgical approach: A case report

Abstract

BACKGROUND Neurogenic heterotopic ossification is an acquired serious complication described in patients with central nervous system disorders and defined by bone formation in non-osseous tissue. CASE SUMMARY We present an unusual case of a 13-yr-old boy presenting with hip pain and severe gait impairment 5 mo after the diagnosis of hemiplegia following a spontaneous intracerebral haemorrhage. Computed tomography revealed bilateral heterotopic ossification of both the paretic and the non-paretic limbs, with entrapment of the sciatic nerve. The choice of surgical or nonsurgical management of such patients depends on the timing of diagnosis, the symptoms, and the extent of maturation of the ossified lesions. Surgical resection remains the only treatment with proven, evidence-based effectiveness. The choice of surgical approach largely depends on the location of the ossified lesions. CONCLUSION We believe the plane of dissection presented is a satisfactory option for resection of a posteromedial mass and sciatic nerve release.

3D-Printed Model in Preoperative Planning of Sciatic Nerve Decompression Because of Heterotopic Ossification

“…I n regard to HO, specifically, 3D printing has been described for preoperative planning of HO resection after femoral neck, elbow, and acetabular fractures, but has not yet been reported with respect to sciatic nerve decompression of the hip [11][12][13][14] . Nóbrega et al 23 augmented sciatic nerve decompression using an electronic 3D model generated by imaging software; however, such models are often limited in axes of rotation and demonstrate all structures simultaneously, thus, potentially impeding full visualization of specific segments of aberrant anatomy. By contrast, 3D-printed SLA models allow for specific anatomy to be selected, allowing for visualization of structures that may otherwise be obscured on radiographic imaging.…”