Neurogenic heterotopic ossification: epidemiology and morphology on conventional radiographs in an early neurological rehabilitation population

Seipel, Rebecca; Langner, Soenke; Platz, Thomas; Lippa, M; Kuehn, Jens Peter; Hosten, Norbert

doi:10.1007/s00256-011-1115-5

Cited by 21 publications

(15 citation statements)

References 19 publications

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“…In fact, HO developed in 65% of service members with combat-related extremity trauma in a study conducted at the National Naval Medical Center between 2003 and 2006 (5). This is very high in comparison to civilian populations, in which the prevalence of HO varies between 2 and 20% with central nervous system or orthopedic injury alone (6,7). However, civilians who have a combined orthopedic injury and central nervous system injury have rates similar to the military population, presumably because many military casualties experience simultaneous orthopedic and traumatic brain injuries due to blasts, the most frequent mechanism of injury in both Iraq and Afghanistan (8,9).…”

Section: Introductionmentioning

confidence: 89%

Pilot study for detection of early changes in tissue associated with heterotopic ossification: moving toward clinical use of Raman spectroscopy

Harris

Cilwa

Elster

et al. 2015

Connective Tissue Research

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Over 60% of combat-wounded patients develop heterotopic ossification (HO). Nearly 33% of them require surgical excision for symptomatic lesions, a procedure that is both fraught with complications and can delay or regress functional rehabilitation. Relative medical contraindications limit widespread use of conventional means of primary prophylaxis, such as nonspecific nonsteroidal anti-inflammatory medications and radiotherapy. Better methods for risk stratification are needed to both mitigate the risk of current means of primary prophylaxis as well as to evaluate novel preventive strategies currently in development. We asked whether Raman spectral changes, measured ex vivo, could be associated with histologic evidence of the earliest signs of HO formation and substance P (SP) expression in tissue biopsies from the wounds of combat casualties. In this pilot study, we compared normal muscle tissue, injured muscle tissue, very early HO lesions (< 16 d post-injury), early HO lesions (> 16 d post-injury) and mature HO lesions. The Raman spectra of these tissues demonstrate clear differences in the Amide I and III spectral regions of HO lesions compared to normal tissue, denoted by changes in the Amide I band center (p < 0.01) and the 1340/1270 cm(-1) (p < 0.05) band area and band height ratios. SP expression in the HO lesions appears to peak between 16 and 30 d post-injury, as determined by SP immunohistochemistry of corresponding tissue sections, potentially indicating optimal timing for administration of therapeutics. Raman spectroscopy may therefore prove a useful, non-invasive and early diagnostic modality to detect HO formation before it becomes evident either clinically or radiographically.

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Section: Introductionmentioning

confidence: 89%

Pilot study for detection of early changes in tissue associated with heterotopic ossification: moving toward clinical use of Raman spectroscopy

Harris

Cilwa

Elster

et al. 2015

Connective Tissue Research

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“…Its incidence varies from 15 % to 35 % [1–3]. This phenomenon is mostly observed about larger joints, hips being the more affected site.…”

Section: Ho In Paraplegiamentioning

confidence: 99%

“…In this phase, HO can cause motion restriction, joint ankylosis and decubiti. In fact, as many as 5–10 % of patients develop complete hip ankylosis [1, 2, 4, 5]. Typically, HO develops between 1 and 5 months after spinal injury, and can continue to be active even 5 years after the onset of paraplegia [6]; in some cases, it never reaches complete maturity [7].…”

Section: Ho In Paraplegiamentioning

confidence: 99%

“…While its etiopathogenesis is unknown, it is likely that more than one factor (vascular stasis, low tissue oxygenation, microtraumas) contributes to activation of osteoblast and chondroblast progenitor cells with a consequent precipitation of calcium salts within the connective tissue [1–3]. Clinically, heterotopic ossification (HO) occurs in rare congenital disorders and, more commonly, in acquired conditions such as after surgery or related to spinal cord or head lesions.…”

Section: Introductionmentioning

confidence: 99%

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Pelvic heterotopic ossification: when CT comes to the aid of MR imaging

et al. 2013

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ObjectiveThis article compares various imaging aspects of magnetic resonance (MR) and computed tomography (CT) of heterotopic ossification (HO) in the pelvic soft tissues in paraplegic patients. Our aim is to highlight the benefits of integrating MR and CT imaging in the diagnosis of immature HO, which may be challenging with MR images alone.MethodsParaplegic patients examined on the same day by contrast-enhanced 0.4-T pelvic MR and unenhanced CT for pressure-sore-related infections were selected. MR imaging was performed on a Hitachi-Aperto 0.4 T; the Open Magnet served as a more favourable configuration for the required limb positioning of these patients. CT images were attained on a six-slice Siemens-Somaton-Emotion.ResultsMR images of HO differ according to the degree of bone maturity. The more immature the HO process, the more heterogeneous is the signal, characterised mostly by focal iso-hypointensity on T1-weighted images and hyperintensity on T2-weighted/short TI inversion recovery (STIR). These characteristics correlate to different CT patterns.ConclusionsMR and CT features of pelvic HO in paralysed patients were reviewed with a focus on the different aspects associated with the degree of ossification. Based solely on the MR findings, immature heterotopic ossification may be difficult to differentiate from other soft tissue pelvic lesions.Teaching points• The pelvis and hip are common locations of heterotopic ossifications (HO), often occurring in paraplegic patients.• With respect to HO, MR imaging allows for a confident diagnosis in mature ossified lesions only. The MR aspect of immature ossification may be confused with other pathologies.• Plain radiographs and CT may show various phases of ossification: amorphous calcification, immature and mature ossification.• Integrating MR with CT can help recognise HO foci and differentiate them from infections and other soft tissue lesions.

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“…Radiographic techniques, including computed tomography (CT) and magnetic resonance imaging (MRI), provide high resolution visualization of late stage HO; however, they have low sensitivity to incremental progression of mineralization and difficulty differentiating HO from surrounding soft tissue, especially early . Combined MRI and CT aids in the early diagnosis of HO; however, this relies on a “wait and see” approach to monitor changes in mineralization over time, which may be unsuitable for diagnosing cases where progression can be detrimental .…”

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confidence: 99%

Early detection of heterotopic ossification using near‐infrared optical imaging reveals dynamic turnover and progression of mineralization following Achilles tenotomy and burn injury

Perosky

Peterson

Eboda

et al. 2014

Journal Orthopaedic Research

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Heterotopic ossification (HO) is the abnormal formation of bone in soft tissue. Current diagnostics have low sensitivity or specificity to incremental progression of mineralization, especially at early time points. Without accurate and reliable early diagnosis and intervention, HO progression often results in incapacitating conditions of limited range of motion, nerve entrapment, and pain. We hypothesized that non-invasive near-infrared (NIR) optical imaging can detect HO at early time points and monitor heterotopic bone turnover longitudinally. C57BL6 mice received an Achilles tenotomy on their left hind limb in combination with a dorsal burn or sham procedure. A calcium-chelating tetracycline derivative (IRDye 680RD BoneTag) was injected bi-weekly and imaged via NIR to measure accumulative fluorescence for 11 wk and compared to in vivo microCT images. Percent retention of fluorescence was calculated longitudinally to assess temporal bone resorption. NIR detected HO as early as five days and revealed a temporal response in HO formation and turnover. MicroCT could not detect HO until 5 wk. Confocal microscopy confirmed fluorophore localization to areas of HO. These findings demonstrate the ability of a near-infrared optical imaging strategy to accurately and reliably detect and monitor HO in a murine model.

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Neurogenic heterotopic ossification: epidemiology and morphology on conventional radiographs in an early neurological rehabilitation population

Abstract: Standard radiographs, as a fast and inexpensive technique, allow the expected size progression of heterotopic ossifications during maturation to be estimated, which is relevant in terms of therapeutic decisions, patient mobilization, and neurological rehabilitation.

Cited by 21 publications

References 19 publications

Pilot study for detection of early changes in tissue associated with heterotopic ossification: moving toward clinical use of Raman spectroscopy

Pilot study for detection of early changes in tissue associated with heterotopic ossification: moving toward clinical use of Raman spectroscopy

Pelvic heterotopic ossification: when CT comes to the aid of MR imaging

Early detection of heterotopic ossification using near‐infrared optical imaging reveals dynamic turnover and progression of mineralization following Achilles tenotomy and burn injury

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