A Systematic Review of Therapeutic Interventions for Heterotopic Ossification Following Spinal Cord Injury

Spinal Cord, 2010 · DOI: 10.1038/sc.2009.175 · Published: July 1, 2010

Spinal Cord Injury Rehabilitation Musculoskeletal Medicine

Simple Explanation

Heterotopic ossification (HO) is the formation of mature bone in soft tissues, often near joints, and is a common complication after spinal cord injury (SCI). This review examines the effectiveness of treatments to prevent and treat HO in SCI patients. The review found that non-steroidal anti-inflammatory drugs (NSAIDs) are effective in preventing HO when given early after SCI. Bisphosphonates can halt the progression of HO once it has developed. Pulse low-intensity electromagnetic field therapy may also help prevent HO by increasing blood flow and oxygenation to the treated area. Surgical removal of heterotopic bone can improve range of motion.

Study Duration

Not specified

Participants

13 studies included, at least 3 SCI subjects per study

Evidence Level

Systematic Review

Key Findings

1
NSAIDs, specifically rofecoxib and indomethacin, reduce the incidence of HO when administered early (3 weeks) after SCI, supported by Level 1 evidence.
2
Bisphosphonates, particularly etidronate, can halt the progression of HO once diagnosed, especially if initiated early (3–6 weeks), with Level 2 evidence.
3
Pulse low-intensity electromagnetic field (PLIMF) therapy is effective in the prophylaxis of HO post SCI, based upon a single RCT, with Level 1 evidence.

Research Summary

This systematic review examined the effectiveness of treatments used to prevent and treat heterotopic ossification (HO) in the spinal cord injury (SCI) population. The review found that pharmacological treatments, particularly NSAIDs for prevention and bisphosphonates for treatment, have the highest level of research evidence supporting their use. The authors conclude that more research is needed into the various clinical interventions used to prevent and treat HO in SCI patients before definitive recommendations can be made.

Practical Implications

Early NSAID Administration

Administering NSAIDs early after SCI can reduce the incidence of HO development.

Bisphosphonate Use

Bisphosphonates can be used to halt the progression of HO once it has been diagnosed, especially if treatment is started early.

PLIMF Therapy Consideration

Pulse low-intensity electromagnetic field therapy can be considered as a prophylactic measure against HO in SCI patients.

Study Limitations

1
Lack of standardization in diagnosing HO post SCI
2
Generally poor quality of the studies
3
Limited published research evidence on the use of radiation in the prevention of HO in the SCI population

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