Prevention and treatment of heterotopic ossification after spinal cord injury.
OBJECTIVE
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.


BACKGROUND
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.


CONCLUSIONS
Preventive use of nonsteroidal antiinflammatory agents (NSAIDs) reduces the incidence of HO by a magnitude of 2 to 3.


RESULTS
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.


CONCLUSIONS
Significant progress has been made in the early prevention and management of HO. Further studies are needed to elucidate the etiology.
Banovac
Kresimir
K
Department of Rehabilitation Medicine (D-461), PO Box 016960, University of Miami School of Medicine, Miami, FL 33101, USA. kresimir@aol.com
Sherman
Andrew L
AL
Estores
Irene M
IM
Banovac
Filip
F
D000894:Anti-Inflammatory Agents, Non-Steroidal / Q000627:therapeutic use; D004359:Drug Therapy, Combination; D012968:Etidronic Acid / Q000627:therapeutic use; D006801:Humans; D009999:Ossification, Heterotopic / Q000209:etiology / Q000517:prevention & control* / Q000601:surgery / Q000628:therapy*; D013119:Spinal Cord Injuries / Q000150:complications*
D000894:Anti-Inflammatory Agents, Non-Steroidal; D012968:Etidronic Acid