Soft Tissue Calcifications in Cord Lesions

Liberson, Miriam

doi:10.1001/jama.1953.03690110024008

Cited by 37 publications

(5 citation statements)

References 3 publications

(1 reference statement)

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“…This extreme difference might result because many publications he reviewed were published in an era before ultrasound was established in clinical practice. [10][11][12][13][14][15][16][17][18][19][20][21] In later studies the risk for HO was found to be comparable to ours. 22,23 One problem in describing HO might be, that examiners quote HO in the gluteal region which do not result from neurogenic edema, but from mostly bedding in supine position and permanent wheel-chair dependency which causes high pressure at the gluteal region.…”

Section: Discussionsupporting

confidence: 73%

Development of heterotopic ossifications, blood markers and outcome after radiation therapy in spinal cord injured patients

et al. 2014

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Study Design: Retrospective study. Objectives: This study was implemented to detect risk factors for the developing of heterotopic ossifications (HOs) in spinal cord injury (SCI) patients. Setting: This study was conducted in Murnau, Germany. Methods: All patients from 2008-2012 with acute SCI were routinely examined by ultrasound of the hips every 2 weeks. The sub group of SCI patients suffering of HO of the hips were extracted and the incidence of developing an HO was calculated. Parameters like age, level of injury, ASIA Impairment Scale (AIS), duration time of accident until diagnosis of HO, Brooker stage, localization of HO (magnetic resonance imaging (MRI)) and symptoms like thrombosis, emboli, decrease of range of motion (ROM), dermal symptoms, swelling, increase in D-Dimere level, were evaluated. Also accompanying injuries of the brain, lung and extremities were recorded. Results: From January 2008 until January 2012, 575 patients with an acute and traumatic SCI were treated in our Department. During this period 32 HOs were detected in the muscles surrounding the hip. In 10 cases a single side and in 22 cases both sides were affected. A total of 26 patients were detected showing up a Brooker 0, two patients Brooker 1, and five patients a Brooker stage 42. The adductor muscles showed an edema in 19 cases and the quadriceps muscles were affected in 15 cases. 26% of all SCI patients showed AIS A status, but in patients who developed HO, 64% have had an AIS A status. 19% of patients with a HO were AIS B and 9.5% showed an AIS C and D. Regarding the level of injury the distribution of patients suffering of HO was comparable to the distribution of SCI patients without HO. In mean HO were detected 9 weeks after SCI and no new HO were found after the 22nd (n = 1) week of injury. Clinical symptoms such as swelling, pain, redness or decrease in ROM or increase in D-Dimere levels were seen in 24 cases. Accompanying injuries like brain injury and lung contusions were found in 83% of patients developing HO. The incidence of thrombosis was comparable to SCI patients without HO. One patient with no accompanying injuries or clinical symptoms was detected by routinely performed ultrasound. Conclusions: The risk of developing HO in patients with traumatic SCI is 5.5% but increases when accompanying injuries of the brain and lung occur. Patients with a neurological status of AIS A must also be quoted as risk patients. When considering the described risk factors and clinical symptoms, 96% of all HO can be detected.

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Section: Discussionsupporting

confidence: 73%

Development of heterotopic ossifications, blood markers and outcome after radiation therapy in spinal cord injured patients

et al. 2014

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“…89 On the other hand, it may be that demineralization of bone accompanied by a loss of calcium and a subsequent loss of collagen as is seen in the acute phase of SCI 102,103 is associated with an increased risk of developing both urinary tract stones, osteoporosis and NHO. 3,4,17,100 As yet, the conclusion seems justi®ed that the relatively high incidence of urinary tract infection and stone formation in SCI patients with NHO is not well understood from a pathophysiological perspective. 21,22 Patients in the acute phase of traumatic SCI are known to be hypercoagulable and at risk of developing thromboembolic complications.…”

Section: Risk Factorsmentioning

confidence: 99%

“…43,44 Although NHO may develop even several years after SCI, it is generally diagnosed between 1 to 6 months post-injury with a peak incidence at 2 months 7,8,10,12,19,22,45 ± 50 Although NHO may begin well before the clinical signs become evident, the initial signs are often seen within the ®rst 3 weeks after SCI. 3,4,7,9,39,51 The most common clinical ®ndings are a decreased joint range of motion and a peri-articular swelling due to interstitial oedema of the soft tissues. 1,7,8,10,30,36,39,45,52,53 In patients with sensory sparing, the ®rst symptom may be pain in the a ected area.…”

Section: Introductionmentioning

confidence: 99%

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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“…Incidence of HO after SCI is 40-50%; [1][2][3][4] in 10-20% of these patients HO develops in a more severe form, which usually needs surgical treatment. 5,6 The etiology of HO remains unknown.…”

Section: Introductionmentioning

confidence: 99%

Prevention of heterotopic ossification after spinal cord injury with COX-2 selective inhibitor (rofecoxib)

et al. 2004

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Study design: A randomized, prospective, double-blind, placebo-controlled clinical trial. Objectives: To determine the effect of COX-2-selective inhibitor on the prevention of heterotopic ossification (HO) after spinal cord injury (SCI). Setting: County and University Teaching Hospital, Miami, FL, USA. Methods: A total of 76 patients were enrolled in the study. Among them, 39 patients received placebo, and 37 received COX-2-selective inhibitor rofecoxib 25 mg daily for a period of 4 weeks. Prevention was started 3 weeks after spinal cord injury (SCI). In both groups of patients there was similar age as well as the level of SCI and ASIA impairment scale. Two methods were used to diagnose early HO, clinical symptoms and bone scintigraphy. Radiography was used for diagnosis of late stages of HO development. Results: A significantly lower incidence of HO was found in the rofecoxib group (13.4%) than in the placebo group (33.3%: Po0.05). In patients receiving rofecoxib, there was a 2.5 times lower relative risk of developing HO than in the placebo group (95% CI, 2.3-6). There were no patients who discontinued the study due to adverse effects of medication. Conclusion: Our data suggest that COX-2-selective inhibitor rofecoxib is an effective medication in prevention of HO after SCI.

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Soft Tissue Calcifications in Cord Lesions

Cited by 37 publications

References 3 publications

Development of heterotopic ossifications, blood markers and outcome after radiation therapy in spinal cord injured patients

Development of heterotopic ossifications, blood markers and outcome after radiation therapy in spinal cord injured patients

Neurogenic heterotopic ossification in spinal cord injury

Prevention of heterotopic ossification after spinal cord injury with COX-2 selective inhibitor (rofecoxib)

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