Prevention of heterotopic ossification after spinal cord injury with indomethacin

Abstract

Study design: A randomized, prospective, double-blind, placebo-controlled clinical trial. Objectives: To determine the e ect of indomethacin on the prevention of heterotopic ossi®cation (HO) following spinal cord injury (SCI). Setting: County Hospital, Miami, Florida, USA. Methods: Sixteen patients were treated with slow-release indomethacin 75 mg daily and 17 patients received placebo for a period of 3 weeks. Prevention was started 21+14 days after SCI. In both groups of patients there was similar age of the patients as well as the level of SCI and ASIA impairment scale. Two methods were used to diagnose HO, bone scintigraphy and radiographic examination. Bone scintigraphy with technetium labeled methylenediphosphonate was used for diagnosis of early stage, while radiography was used for diagnosis of late stage of HO development. Results: A signi®cantly lower incidence of early HO was found in the indomethacin group (25%) than in the placebo group (65%; P50.001). Similarly there was a signi®cant reduction of late HO in the indomethacin group (12.5%) as compared to the placebo group (41%; P50.001). Conclusion: Our data suggest that indomethacin used during the ®rst 2 months after SCI is e ective in prevention of HO in a signi®cant number of patients.

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

“…There were 13 studies that met the inclusion criteria; this included four prophylaxis 1,3,22,23 and nine treatment [24][25][26][27][28][29][30][31][32][33][34][35] studies of HO. Three of these intervention studies had Level 1,3,22,23 two Level 2, 24,25 seven Level 4 [26][27][28][29][32][33][34][35] and one Level 5 1 evidence.…”

“…Three of these intervention studies had Level 1,3,22,23 two Level 2, 24,25 seven Level 4 [26][27][28][29][32][33][34][35] and one Level 5 1 evidence.…”

“…1 Reported incidence varies greatly in the SCI population, ranging from 10-53%. 2,3 HO begins to develop most frequently within the first 2-3 weeks after SCI and occurs below the level of paralysis, usually at the hip (70-97%) and followed by the knee. 2,3 In patients with SCI with clinically significant HO, 20-30% present with a reduction in joint range of motion, whereas only 3-8% develop ankylosis.…”

“…2,3 HO begins to develop most frequently within the first 2-3 weeks after SCI and occurs below the level of paralysis, usually at the hip (70-97%) and followed by the knee. 2,3 In patients with SCI with clinically significant HO, 20-30% present with a reduction in joint range of motion, whereas only 3-8% develop ankylosis. 2 Initial clinical features of HO may include joint and muscle pain, decreased range of motion, tissue swelling, redness and heat in the involved region, as well as a lowgrade fever.…”

Neurogenic heterotopic ossification in spinal cord injury

“…Both treatments, however, do not in¯uence the ectopic bone already formed, and are, therefore, e ective only in the early stages of NHO. 158,165,166 More controlled studies are needed to determine the e ectiveness and complication rates of di erent (prophylactic) treatments for NHO in SCI patients.…”