Heterotopic ossification after spinal cord injury. Epidemiology and risk factors

Rh, Wittenberg; Peschke, U; Bötel, U

doi:10.1302/0301-620x.74b2.1544955

Cited by 135 publications

(78 citation statements)

References 15 publications

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“…Although the precise pathophysiology of NHO is still unknown, humoral, 26,79 ± 85 neural, 1,3,6,36,46,48,73,86 ± 89 and local factors 12,27,90 ± 92 probably all play a role in the formation of ectopic bone. Apart from the completeness of SCI 1,13,14,19,21,22,24,88 and the possible role of (micro) trauma, 6,9,17,46,51,107 ± 112 reports of possible risk factors like DVT, pressure ulceration, infection, and spasticity 6,7,10,14,21,22,24,30,47,89 and their presumed causal relationship with NHO are inconclusive. Studies on experimental bone induction have emphasized the role of neuro-immunological and humoral factors.…”

Section: Resultsmentioning

confidence: 99%

“…DVT: deep venous thrombosis higher incidence has been suggested for (young) male patients. 10,13,14,17,24,47 A genetic predisposition for NHO based on human lymphocyte antigen (HLA)-typing has also been suggested. The human leukocyte antigen system (HLA) consists of a series of glycoprotein molecules that appear on the surface of virtually all nucleated cells.…”

Section: Risk Factorsmentioning

confidence: 99%

“…Although Catz et al 37 did not ®nd a relationship between radiologically diagnosed NHO and the severity of the motor de®cits, other authors have reported that complete transverse SCI is more commonly associated with NHO than incomplete SCI with relative risks (RR) reported between 2.0 ± 4.2. 1,13,14,19,21,22,24,88 Also, NHO is less frequently reported (55%) in patients with lumbosacral or conus-cauda lesions, which regain or retain ambulation. 88 Other clinical factors associated with NHO are the presence of pressure sores, 6,21,22,24,30,47 urinary tract infections or renal stones, 3,4,6,24,100 deep venous thrombosis (DVT), 24 severe spasticity, 22 and (micro) trauma.…”

Section: Risk Factorsmentioning

confidence: 99%

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Neurogenic heterotopic ossification in spinal cord injury

2002

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Neurogenic heterotopic ossi®cation (NHO) is a frequent complication in spinal cord injury (SCI) that is often di cult to treat. This review emphasizes the incidence, risk factors and clinical signs of NHO in SCI patients. Although the exact pathophysiology underlying NHO in neurologic patients is not yet understood, di erent pathogenic mechanisms have been proposed in the literature. A selection of the most important theories will be given and discussed. Moreover the di erent diagnostic, therapeutic, and preventive methods currently used in NHO management after SCI will be reviewed.

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Section: Resultsmentioning

confidence: 99%

Section: Risk Factorsmentioning

confidence: 99%

Section: Risk Factorsmentioning

confidence: 99%

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Neurogenic heterotopic ossification in spinal cord injury

2002

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“…[13][14][15][16] A causal relationship between these factors and the development of HO after SCI has yet to be determined.…”

Section: Introductionmentioning

confidence: 99%

A systematic review of the therapeutic interventions for heterotopic ossification after spinal cord injury

et al. 2010

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Study design: Systematic review. Objective: To conduct a systematic review of the effectiveness of interventions used to prevent and treat heterotopic ossification (HO) after spinal cord injury (SCI). Setting: St Joseph's Parkwood Hospital, London, Ontario, Canada. Methods: MEDLINE, CINAHL, EMBASE and PsycINFO databases were searched for articles addressing the treatment of HO after SCI. Studies were selected by two reviewers and were only included for analysis if at least 50% of the subjects had an SCI, there were at least three SCI subjects and if the study subjects participated in a treatment or intervention. Study quality was assessed by two independent reviewers using the Downs and Black evaluation tool for all studies, as well as the PEDro assessment scale for randomized control trials only. Levels of evidence were assigned using a modified Sackett scale. Results: A total of 13 studies met the inclusion criteria. The selected articles were divided into prevention or treatment of post-SCI HO. Nonsteroidal anti-inflammatory drugs (NSAIDs), warfarin, and pulse low-intensity electrogmagnetic field (PLIMF) therapy were reviewed as prophylactic measures. Bisphosphonates, radiotherapy and excision were reviewed as treatments of post-SCI HO. Conclusions: Pharmacological treatments of HO after SCI had the highest level of research evidence supporting their use. Of these, NSAIDs showed greatest efficacy in the prevention of HO when administered early after an SCI, whereas bisphosphonates were the intervention with strongest supportive evidence once HO had developed. Of the non-pharmacological interventions, PLIMF was supported by the highest level of evidence; however, more research is needed to fully understand its role.

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“…It has been observed to be present as early as 18 days after SCI, 10 which is earlier than the time period of 1 ± 6 months after other injuries. 9,10 It is more common after injury of the lower cervical or thoracic spine than after those of lumbar spine 8 and it occurs in both¯accid and spastic forms of paralysis. Although ossi®cation is almost always seen in a paraplegic limb or limbs, this association is not constant.…”

Section: Discussionmentioning

confidence: 99%

Influence of heterotopic ossification of the hip on bone densitometry: a study in spinal cord injured patients

et al. 1998

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Objective: To evaluate (1) the magnitude of falsely elevated bone density results caused by heterotopic ossi®cation (HO) around the hip and (2) e ect of age of patients when the measurement was taken, age of patients at injury, and age of injury (time since event) to the prevalence of HO. Subjects and methods: We blindly analyzed plain radiographs of the hip [(obtained within 1 month of dual energy X-ray absorptiometry (DEXA)] in 107 spinal cord injured (SCI) patients for HO and matched the result to the three regions of interest (ROI): the femoral neck, Ward's triangle, and the trochanter. The in¯uence of HO on bone densitometric values was determined by the analysis of variance (ANOVA) and post-hoc analysis. Results: Nineteen (18%) patients had HO; overlying the femoral neck (79%), trochanter (74%) and Ward's triangle (37%), respectively. Signi®cant elevation of densitometric values (P50.05 or less) was observed in a various magnitude at each ROI, with the greatest elevation at Ward's triangle. The prevalence of HO was high when the patients were injured at age range of 20 ± 39 years. Conclusions: HO around the hip can cause signi®cantly elevated bone densitometry results at all ROIs, which can obscure underlying osteoporosis, leading to underestimation of fracture risk. Determination of bone density in this region with corresponding plain radiographs would be of help. In SCI patients, prevalence of HO was high when the age of patients at injury was 20 ± 39 years.

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Heterotopic ossification after spinal cord injury. Epidemiology and risk factors

Cited by 135 publications

References 15 publications

Neurogenic heterotopic ossification in spinal cord injury

Neurogenic heterotopic ossification in spinal cord injury

A systematic review of the therapeutic interventions for heterotopic ossification after spinal cord injury

Influence of heterotopic ossification of the hip on bone densitometry: a study in spinal cord injured patients

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