Background/objectives: Heterotopic ossification (HO) is a frequent, irreversible complication after spinal cord injury (SCI). The objective of this article is to explain the etiology of HO; present new advances in prevention, diagnosis, and management of this complication; and provide a suggested algorithm for clinical management.
Etiology: Although still hypothetical, trauma and overexpression of bone morphogenic protein(s) in traumatized soft tissue appear to play important roles as initiating factors of HO.
Prevention: Preventive use of nonsteroidal antiinflammatory agents (NSAIDs) reduces the incidence of HO by a magnitude of 2 to 3.
Management: Early determination of serum creatine phosphokinase may have a diagnostic value in predicting the onset and severity of HO, and an NSAID may be added to etidronate therapy in the initial inflammatory phase of HO formation until C-reactive protein levels return to normal range. Surgery is indicated in a subset of patients, and a regimen that includes radiation therapy may prevent postoperative recurrence.
Conclusion: Significant progress has been made in the early prevention and management of HO. Further studies are needed to elucidate the etiology.
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