Experience With Surgical Resection of Heterotopic Bone in Spinal Cord Injury Patients

Stover, Samuel L.; Niemann, Kurt M. W.; Tulloss, James R.

doi:10.1097/00003086-199102000-00007

Cited by 81 publications

(91 citation statements)

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“…49,174 ± 176 Moreover, intra-and post-operative fracturation of bone may occur in the case of severe osteoporosis. Stover 174 has reported intra-operative fracturation of the femoral head in 5% and post-operative (spontaneous) fracturation in 3 ± 16% of the SCI patients operated for NHO around the hip joint. Since other authors mention a higher percentage (29%) 175 of SCI patients with femoral heads too brittle to preserve during operation, the real incidence of this problem may be even higher.…”

Section: Surgical Resectionmentioning

confidence: 99%

“…172 ± 175 However, operative resection of NHO has been associated with severe complications and poor outcome. 171 These complications include deep (2 ± 5%) 174,175 or super®cial infection (7 ± 38%), 45,49,174,175 post-operative haemorrhage (5 ± 38%), 45,173 and excessive intra-operative bleeding requiring (multiple) blood transfusions (9 ± 83%). 49,174 ± 176 Moreover, intra-and post-operative fracturation of bone may occur in the case of severe osteoporosis.…”

Section: Surgical Resectionmentioning

confidence: 99%

“…The post-operative recurrence of NHO depends on the de®nition used and the followup period. Radiographic signs of NHO recurrence have been mentioned in 82 ± 100% of the operated SCI patients, 45,49,173,174 although clinically signi®cant NHO would develop in only 17 ± 58% of the cases. 10,45,49,173,174,176 It has been suggested that the recurrence after resection can be reduced if NHO is removed only once the ®rst and second phase of the bone scan have normalized.…”

Section: Surgical Resectionmentioning

confidence: 99%

“…Radiographic signs of NHO recurrence have been mentioned in 82 ± 100% of the operated SCI patients, 45,49,173,174 although clinically signi®cant NHO would develop in only 17 ± 58% of the cases. 10,45,49,173,174,176 It has been suggested that the recurrence after resection can be reduced if NHO is removed only once the ®rst and second phase of the bone scan have normalized. 10,52,115,129,132 However, such a maturity rating does not guarantee that NHO recurrence is unlikely.…”

Section: Surgical Resectionmentioning

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: Surgical Resectionmentioning

confidence: 99%

Section: Surgical Resectionmentioning

confidence: 99%

Section: Surgical Resectionmentioning

confidence: 99%

Section: Surgical Resectionmentioning

confidence: 99%

See 2 more Smart Citations

Neurogenic heterotopic ossification in spinal cord injury

2002

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“…1 8 Surgical resection of matured ectopic bone should be contemplated in cases where there is significant func tional limitation of joint mobility. 19 Recurrence of HO after resection though is a major concern. In this respect, it is interesting to note that the combination of indomethacin and disodium etidronate has been shown to be effective in the prevention of recurrence of HO .…”

Section: Discussionmentioning

confidence: 99%

Prolonged fever and heterotopic ossification in a C4 tetraplegic patient. Case report

Tow

Kong

1995

Spinal Cord

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Prolonged fever is an uncommon diagnostic problem in a spinal cord injury patient. The underlying causes include recurrent infections, thromboembolic phenomena and central fever. We report a case of heterotopic ossification in a traumatic C4 tetraplegic patient presenting as prolonged fever of 3 months' duration. Treatment with oral indomethacin led to prompt resolution of the fever and acute manifestations of heterotopic ossification. The efficacy of indomethacin in the treatment of heterotopic ossification in spinal cord injury needs to be further confirmed in larger studies.

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Heterotopic ossification in the setting of neuromuscular blockade

Goodman

Merkel

Perlmutter

et al. 1997

Arthritis & Rheumatism

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Objective. Heterotopic ossification (HO) is a disorder characterized by the formation of new bone in tissue that does not ossify under normal conditions. We report a series of 6 cases in which HO occurred in the setting of adult respiratory distress syndrome (ARDS). We wished to show that HO can occur after neuromuscular blockade and that these cases might provide additional evidence that HO is influenced by neural mechanisms.Methods. Cases of HO were selected from the consultation services at the Massachusetts General Hospital and the Brigham and Women's Hospital. Affected patients all had ARDS and had been treated with a neuromuscular blocking agent. Patients with a history of stroke, burn, head trauma, spinal cord injury, or joint replacement were excluded from this study.Results. Heterotopic bone appeared around large joints in a pattern identical to that seen in patients with paralysis, traumatic brain injury, severe burns, or trauma. New bone formation was self-limited over a period of 1-2 years. Alkaline phosphatase and technetium bone scan were sensitive ways of detecting early disease and monitoring disease activity. Medical therapies had limited benefit. Surgical excision of mature new bone appeared to be the only definitive therapy.Conclusion. Neuromuscular blockade in the setting of ARDS appears to be an important risk factor for the development of HO. The similarity of these cases of HO occurring in patients with brain or spinal cord injury raises the possibility that neural mechanisms

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Experience With Surgical Resection of Heterotopic Bone in Spinal Cord Injury Patients

Cited by 81 publications

References 0 publications

Neurogenic heterotopic ossification in spinal cord injury

Neurogenic heterotopic ossification in spinal cord injury

Prolonged fever and heterotopic ossification in a C4 tetraplegic patient. Case report

Heterotopic ossification in the setting of neuromuscular blockade

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