title: A comparison of heterotopic ossification treatment within the traumatic brain and spinal cord injured population: An evidence based systematic review.
abstract: BACKGROUND
  To compare the treatment of heterotopic ossification (HO) within the traumatic brain and spinal cord injured populations.
  
  
  METHODS
  MEDLINE/Pubmed, CINAHL, EMBASE, and PsycINFO databases were searched for articles addressing treatment of HO post-injury. Articles were constrained to: English language and human subjects. Studies were included if: n ≥ 50% of the subjects had a spinal cord injury (SCI) or a traumatic brain injury (TBI), n ≥ 3 SCI or TBI subjects, and study subjects participated in a treatment or intervention. Study quality, for randomized control trials (RCTs), were assessed using the PEDro assessment scale, while non-RCTs was assessed using the Downs and Black evaluation tool. A modified Sackett scale was used to apply levels of evidence for each intervention.
  
  
  RESULTS
  In total 26 studies (NTBI = 12; NSCI = 14) met inclusion criteria. The majority of studies (10/12) conducted in the TBI population were surgical interventions. Studies conducted with the SCI population investigated diverse pharmacological treatments including: bisphosphonates, non-steroidal anti-inflammatory drugs (NSAIDs) and Warfarin. Non-pharmacological studies investigated the benefits of pulse low-intensity electromagnetic field therapy, surgical excision, and radiotherapy in the treatment of HO.
  
  
  CONCLUSIONS
  Within the SCI literature, NSAIDs showed the greatest efficacy in the prevention of HO when administered early after a SCI, and biphosphonates were found to be the most effective treatment strategy. In the TBI population, surgical excision was the most effective treatment.
authors: Lawson Health Research Institute, St. Joseph’s Parkwood Hospital, London, ON, Canada. JoAnne.Aubut@sjhc.london.on.ca
authors: Jo-Anne L
authors: JA
authors: Aubut
authors: Swati
authors: S
authors: Mehta
authors: Nora
authors: N
authors: Cullen
authors: Robert W
authors: RW
authors: Teasell
mesh_terms: D001930:Brain Injuries / Q000150:complications*; D016206:Databases, Bibliographic / Q000706:statistics & numerical data; D019317:Evidence-Based Medicine; D006801:Humans; D009999:Ossification, Heterotopic / Q000175:diagnosis / Q000209:etiology* / Q000628:therapy*; D013119:Spinal Cord Injuries / Q000150:complications*