Beliefs relating to recurrence of heterotopic ossification following excision in patients with spinal cord injury: a review

Abstract

Study design: Review of the literature. Objectives: It is widely believed that the timing of surgery and the size of the initial Neurological Heterotopic Ossification (NHO) affect the recurrence risk of NHO after SCI. A large number of studies were published in the 80s and the 90s, mostly of poor quality despite the fact that they were carried out by experienced surgical teams. The aim of this study was to suggest recommendations relating to the timing of excision of heterotopic ossification after SCI following the analysis of a recent review of the literature. Setting: France. Methods: A systematic literature search was performed in the PubMed Embase from January 2002 until June 2014 using the MESH headings 'spinal cord injury', 'paraplegia', 'heterotopic ossification' and 'surgery'. Results were compared with results from epidemiological studies based on the BANKHO database (patients who underwent surgery for troublesome HO after central neurological system (CNS) lesions in our center (357 patients, 539 surgeries)). Results: Few studies were found in the literature, results were sometimes contradictory and practices heterogeneous. Results from the BANKHO database showed that troublesome recurrence of NHO was not associated with 'early' surgery (before 6 months), and no association was found between recurrence and the size of the NHO around the joint (Brooker status). Conclusion: We suggest that surgical excision of the NHO should be carried out when it begins to be troublesome, as soon as comorbid factors are under control and the HO is sufficiently constituted for excision.

Spinal kord hasarlı hastanın rehabilitasyonu

“…Santral nörolojik sistem lezyonu sonrası genelllikle iki hafta ila üç ay içinde ortaya çıkar. [21] HO'nun nedeni tam olarak anlaşılamamıştır. Patofizyolojik olarak mezenkimal hücrelerin çoğalması ve osteoblastlara farklılaşması ile ekstrasellüler matriks meydana gelir.…”

“…Aylar içinde bu matriks kalsifiye olur. [21] Son yıllarda; komplet OY (ABS A), eş zamanlı torasik travma, spastisite, trakeostomi, pnömoni ve üriner sistem enfeksiyonları risk faktörleri olarak tanımlanmıştır. [22] En sık kalça ekleminde olmak üzere azalan sıklıkta diz, omuz ve dirsekte görülür.…”

“…Eklem hareket açıklığında azalma ve ankiloz ile fonksiyonel disabiliteye, bulunduğu yere göre damar ve sinir basılarına neden olabilir. [21] Ayırıcı tanıda DVT, enfeksiyon, travma, gelişmekte olan bası yarası akla gelmelidir. Tanıda, erken dönemde klinik, serum alkalen fosfataz yüksekliği ve 99 mTc difosfonat ile üç fazlı kemik sintigrafisinde tutulum yardımcı olur.…”

Heterotopic Ossification – Complication or Chance?

“…Nevertheless, it appears to be desirable to await the maturation phase of the HOusually 1 to 1.5 years after the underlying traumain view of the major intraoperative tissue damage. An alternative possibility is only to perform the operation when mechanical impairment has become measurable [65,67]. Imaging procedures should be carried out in advance, so that any surgery can be properly planned [68], as it is often difficult to identify HO intraoperatively.…”

Surgical Excision of Heterotopic Ossification Leads to Re-Emergence of Mesenchymal Stem Cell Populations Responsible for Recurrence

“…As a result, HO resection may be incomplete. Finally, patients who undergo surgical excision have been noted to develop recurrences in the site of HO [] (Fig. 1B–1D).…”