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Cureus 2021 Apr 27;13(4):e14709. Epub 2021 Apr 27.

3rd Department of Neurology, National and Kapodistrian University of Athens, Aiginition Hospital, Athens, GRC.

The term neurogenic heterotopic ossification (NHO) is used to describe the pathological bone formation in soft tissues, due to spinal cord or brain injury. Commonly is presented with pain and stiffness of the affected joint. NHO affects the quality of life of these patients, delays their rehabilitation and therefore increases morbidity. Read More

Arthrosc Tech 2021 Apr 22;10(4):e1179-e1186. Epub 2021 Apr 22.

Department of Orthopedic Surgery, University of Wisconsin-Madison, Madison, Wisconsin, U.S.A.

Heterotopic ossification (HO) can occur as a complication of various pathologies affecting the hip including trauma, tendon avulsions, chronic injury, spinal cord injury, and soft-tissue disruption caused by surgery. When HO is present alongside intra-articular hip pathology such as femoroacetabular impingement syndrome (FAIS) or labral pathology, consideration should be made to combine the surgical excision of the HO with the FAIS decompression or labral repair if the location and size of the HO is appropriate for arthroscopic excision. Often times, the HO is located in such a position that any central compartment work can be completed before turning to the HO excision. Read More

Int J Environ Res Public Health 2021 04 16;18(8). Epub 2021 Apr 16.

Department of Rehabilitation, Collegium Medicum in Bydgoszcz, Nicolaus Copernicus University in Toruń, 85-094 Bydgoszcz, Poland.

Diagnosis of the cause of massive edema of the lower limbs in patients after spinal cord injury (SCI) can be difficult because of loss of pain sensation, commonly occurring in this group of patients. This paper reviews several different pathologies that can lead to lower-limb edema and the associated diagnostic difficulties. We present four cases of patients with massive edemas of lower limbs at different times after SCI undergoing treatment in the Department of Rehabilitation, University Hospital in Bydgoszcz, Poland. Read More

J Neurotrauma 2021 Apr 29. Epub 2021 Apr 29.

The University of Queensland Faculty of Medicine, 420004, Mater Research Institute, Woolloongabba, Queensland, Australia;

Neuro-immune dysfunction is thought to promote the development of several acute and chronic complications in spinal cord injury (SCI) patients. Putative roles for adrenal stress hormones and catecholamines are increasingly being recognized, yet how these adversely affect peripheral tissue homeostasis and repair under SCI conditions remains elusive. Here we investigated their influence in a mouse model of SCI with acquired neurogenic heterotopic ossification. Read More

Medicine (Baltimore) 2021 Mar;100(11):e24241

Department of Spine Surgery, The Second Hospital of Jilin University.

Rationale: Intraoperative neurophysiological monitoring (IONM) is widely used in spinal surgeries to prevent iatrogenic spinal cord injury (SCI). Most surgeons focus on avoiding neurological compromise intraoperatively, while ignoring the possibility of nerve damage preoperatively, such as neck positioning. Thus, this study aims to report a case with transient neurological deterioration due to improper neck position detected by IONM during cervical surgery. Read More

Biomed Res Int 2021 25;2021:8834795. Epub 2021 Jan 25.

School of Biomedical Engineering, Guangdong Provincial Key Laboratory of Medical Image Processing, Southern Medical University, Guangzhou 510515, China.

The positive effect of low-intensity pulsed ultrasound (LIPUS) on bone fracture healing has been proved. However, during the period of LIPUS therapy, it is undetermined whether LIPUS promotes the formation of heterotopic ossification (HO), which usually occurs in muscle tissues after trauma such as bone fracture and spinal cord injury. Here, we used 6-week LIPUS therapy in a 42-year-old Chinese male patient with a fracture nonunion in combination with ultrasonography for monitoring fracture healing and HO formation. Read More

J Endourol Case Rep 2020 29;6(4):287-290. Epub 2020 Dec 29.

Division of Urology, University of Nebraska Medical Center, Omaha, Nebraska, USA.

Heterotopic ossification (HO) is the presence of bone in soft tissue where bone normally does not exist. This can be acquired or inherited with the acquired form most often seen with either trauma, spinal cord injury, or central nervous system injury. HO most commonly affects the flexors and abductors of the hip, medial knees, and the shoulders and rarely affects the genitourinary (GU) system. Read More

Eur J Phys Rehabil Med 2021 Jan 15. Epub 2021 Jan 15.

Department of Physical Medicine and Rehabilitation, CIC-IT 1429, Raymond-Poincaré Hospital, Assistance Publique, Hôpitaux de Paris (AP-HP), Garches, France -

Background: Heterotopic ossification (HO) is defined as the formation of endochondral bone within soft tissue. Non-genetic forms, mainly corresponding to a consequence of bone, brain or spinal cord injury, are the most common. HO leads to important functional limitations and alteration of quality of life. Read More

J Int Med Res 2021 Jan;49(1):300060520985383

Department of Orthopaedic Surgery, XuZhou Central Hospital, XuZhou, JiangSu Province, China.

Objective: This study was performed to evaluate the role of posterior suspension of the laminae-ossification of the ligamentum flavum complex combined with miniplate fixation (modified expansive thoracic laminoplasty) in treating thoracic ossification of the ligamentum flavum (TOLF).

Methods: Eight patients with TOLF treated by modified expansive thoracic laminoplasty were retrospectively analyzed. Their general information, operative time, intraoperative blood loss, and postoperative complications were recorded. Read More

Int J Surg Case Rep 2020 7;77:467-471. Epub 2020 Nov 7.

Department of Orthopedic Surgery, College of Medicine, Prince Sattam Bin Abdulaziz University, Al-Kharj, Saudi Arabia.

Introduction: Heterotopic ossification (HO) is the abnormal bone formation in soft tissue where bone normally does not exist. HO can occur secondary to musculoskeletal trauma, burns, spinal cord injury, or traumatic head injury. The treatment of HO ranges from simple medical treatment to advance surgical intervention; it is largely dependent on the amount of bone formation, the location, the limitation of motion, and the severity of the joint disease. Read More

Bone Res 2020 Dec 9;8(1):42. Epub 2020 Dec 9.

Department of Neuroscience, Central Clinical School, Monash University, Melbourne, VIC, Australia.

Neurological heterotopic ossification (NHO) is a debilitating condition where bone forms in soft tissue, such as muscle surrounding the hip and knee, following an injury to the brain or spinal cord. This abnormal formation of bone can result in nerve impingement, pain, contractures and impaired movement. Patients are often diagnosed with NHO after the bone tissue has completely mineralised, leaving invasive surgical resection the only remaining treatment option. Read More

Cureus 2020 Oct 27;12(10):e11200. Epub 2020 Oct 27.

Medicine, University of Illinois at Urbana-Champaign, Champaign, USA.

Extracorporeal shock wave therapy (ESWT) is a non-invasive therapeutic method used for pain management and muscle strength improvement through the use of shock waves. In vitro studies have demonstrated that shockwave therapy induces fluctuation in redox reaction regulation and increases in Mitogen-Activated Protein Kinase (MAPK) signal transduction pathways, stimulating increased gene expression in the nucleus. ESWT has also been shown to upregulate angiogenesis and growth factors through activation of endothelial nitric oxide synthase (eNOS) and vascular endothelial growth factor (VEGF). Read More

Curr Osteoporos Rep 2020 Dec 21;18(6):666-676. Epub 2020 Oct 21.

Mater Research Institute, The University of Queensland, Translational Research Institute, 37 Kent Street, Woolloongabba, Queensland, 4102, Australia.

Purpose Of Review: Neurogenic heterotopic ossification (NHO) is the abnormal formation of extra-skeletal bones in periarticular muscles after damage to the central nervous system (CNS) such as spinal cord injury (SCI), traumatic brain injury (TBI), stroke, or cerebral anoxia. The purpose of this review is to summarize recent developments in the understanding of NHO pathophysiology and pathogenesis. Recent animal models of NHO and recent findings investigating the communication between CNS injury, tissue inflammation, and upcoming NHO therapeutics are discussed. Read More

J Vasc Surg Cases Innov Tech 2020 Sep 17;6(3):479-482. Epub 2020 Jul 17.

Division of Cardiology, Department of Internal Medicine, National Cheng Kung University Hospital, College of Medicine, National Cheng Kung University, Tainan, Taiwan.

Heterotopic ossification (HO) in patients with spinal cord injury could lead to local tissue swelling and sometimes mimic the clinical presentation of deep vein thrombosis. Recognition and effective management is critical. We report the case of a bedridden patient with spinal cord injury presenting with diffuse right lower limb swelling caused by external venous compression from HO. Read More

Spinal Cord 2021 Jun 1;59(6):635-641. Epub 2020 Sep 1.

National Spinal Injuries Centre, Stoke Mandeville Hospital, Buckingahmshire Healthcare NHS Trust, Aylesbury, UK.

Study Design: Prospective observational study.

Objective: To evaluate pelvic MRI muscle signal changes and their association with early heterotopic ossification (HO) in patients with spinal cord injuries.

Setting: National Spinal Injuries Unit, Stoke Mandeville, UK. Read More

J Spinal Cord Med 2020 Aug 18:1-4. Epub 2020 Aug 18.

Department of Rehabilitation Medicine, College of Medicine, Yeungnam University, Daegu, Republic of Korea.

: Deep vein thrombosis (DVT), a frequent complication of spinal cord injury, is occasionally caused by neurogenic heterotopic ossification (NHO). In most cases of NHO, the hip joint is affected. Herein, we present a case of paraplegia following radiation-induced myelopathy that presented with left leg swelling due to DVT in the common iliac vein (CIV) caused by venous compression by NHO on the anterior lower lumbar spine. Read More

World Neurosurg 2020 08;140:556-563

Department of Neurosurgery, K.E.M. Hospital and Seth G.S. Medical College, Mumbai, India.

Background: Ossification of the posterior longitudinal ligament (OPLL) is a hyperostotic condition resulting in a progressive narrowing of the spinal canal and subsequent neurologic deficits. Although systemic and local factors in combination with genetic abnormality have been considered in its etiopathogenesis, OPLL remains a poorly understood pathology. Surgical management of OPLL and the choice of the most appropriate treatment are still controversial issues. Read More

World Neurosurg 2020 08;140:548-555

Department of Neurosurgery, University of Bari Medical School, Bari, Italy.

Background: Cervical spondylotic myelopathy (CSM) is a degenerative disease that represents the most common spinal cord disorder in adults. The best treatment option has remained controversial. We performed a prospective study to evaluate the clinical, radiographic, and neurophysiologic outcomes for anterior cervical corpectomy in the treatment of CSM. Read More

World Neurosurg 2020 11 8;143:e581-e589. Epub 2020 Aug 8.

Department of Orthopaedics, University of Rochester Medical Center, Rochester, New York, USA. Electronic address:

Objective: We sought to evaluate the influence of trauma-induced spinal cord injury (SCI) on the operative management of cervical ossification of the posterior longitudinal ligament (OPLL) in a North American cohort.

Methods: A retrospective chart review was performed for all patients who underwent surgical management for OPLL in an academic medical center between November 2006 and July 2019. Patients were categorized into 1 of 2 groups and compared on the basis of their initial presentation: 1) SCI with OPLL or 2) cervical myelopathy (CM) with OPLL. Read More

Global Spine J 2020 Sep 19;10(6):715-719. Epub 2019 Aug 19.

BG-University Hospital Bergmannsheil, Ruhr University Bochum, Bochum, Germany.

Study Design: Retrospective observational study.

Objectives: To analyze the clinical and radiological outcomes of lower limb fractures following surgical treatment in patients with chronic spinal cord injury (SCI).

Methods: Between January 2003 and December 2015, 102 chronic SCI patients with a lower limb fracture were surgically treated at our hospital. Read More

J Rehabil Med 2020 05 31;52(5):jrm00066. Epub 2020 May 31.

U1179 INSERM, Université Versailles Saint Quentin en Yvelines, UFR des Sciences de la Santé - Simone Veil, 78170 Montigny le Bretonneux, France. E-mail.

Objective: To evaluate recurrence and early postoperative complications (sepsis) following surgical excision combined with radiotherapy for troublesome hip heterotopic ossification in patients with spinal cord injury and traumatic brain injury.

Design: Retrospective case-control study.

Setting: Data relating to patients with spinal cord injury or traumatic brain injury who underwent surgical excision of hip heterotopic ossification were retrieved from the BANKHO database. Read More

Spinal Cord Ser Cases 2020 05 13;6(1):41. Epub 2020 May 13.

Surgical Services, VA Palo Alto Health Care System, Palo Alto, CA, USA.

Introduction: Patients with complete spinal cord injury (SCI) may develop concurrent sequalae that interact and share symptoms; thus, a careful approach to diagnosis and management of new symptoms is crucial.

Case Presentation: A patient with prior T4 complete SCI presented with progressive autonomic nervous system (ANS) dysfunction. The initial differential diagnosis included syringomyelia and lumbar Charcot arthropathy. Read More

J Spinal Cord Med 2020 May 12:1-5. Epub 2020 May 12.

Department of Rehabilitation Medicine, Huashan Hospital, Fudan University, Shanghai, People's Republic of China.

Heterotopic ossification is characterized by abnormal growth of bone in soft tissues. Neurogenic heterotopic ossification is also closely related to central nervous system injuries and has been reported to respond to radial extracorporeal shock wave therapy. In this case, a radial extracorporeal shock wave therapy (five times per week, lasted for almost one year) was applied to a patient with neurogenic heterotopic ossification on the left hip as a result of spinal cord injury. Read More

Clin Neurol Neurosurg 2020 08 1;195:105821. Epub 2020 May 1.

Mayo Clinic Neuro-Informatics Laboratory, Department of Neurologic Surgery, Mayo Clinic, Rochester, MN, USA; Department of Neurologic Surgery, Mayo Clinic, Rochester, MN, USA. Electronic address:

Heterotopic Ossification (HO) refers to the formation of bone within soft tissue. Traumatic spinal cord injury (SCI) has been shown to be associated with development of HO. However, risk factors for HO following SCI are unknown. Read More

Med Sci Monit 2020 Apr 29;26:e921129. Epub 2020 Apr 29.

Orthopedic Department, Peking University Third Hospital, Beijing, China (mainland).

BACKGROUND Circumferential decompression (CD) is an essential treatment option for myelopathy associated with thoracic-ossification of the posterior longitudinal ligament (T-OPLL) when laminectomy cannot achieve sufficient ventral decompression. Although intraoperative neurophysiological monitoring (IONM) is widely used, the operation has a relatively high risk. This study is the first to describe the use of contrast-enhanced ultrasound (CEUS) to evaluate the spinal cord blood flow (SCBF) during thoracic spine surgery in humans. Read More

Clin Neurol Neurosurg 2020 07 6;194:105814. Epub 2020 Apr 6.

Department of Orthopedic Surgery, Yamaguchi University Graduate School of Medicine, Yamaguchi, Japan.

Study Design: This was a retrospective study of prospectively collected data.

Objective: This study aimed to characterize the factors associated with the development of myelopathy at each cervical level based on spinal cord evoked potentials (SCEPs) and radiological parameters in patients with cervical ossification of the posterior longitudinal ligament (OPLL).

Summary Of Background Data: Static factors, dynamic factors, and combinations of these factors are associated with the development of OPLL-related myelopathy. Read More

Clin Neurol Neurosurg 2020 06 17;193:105737. Epub 2020 Feb 17.

Mayo Clinic Neuro-Informatics Laboratory, Department of Neurologic Surgery, Mayo Clinic, Rochester, MN, USA; Department of Neurologic Surgery, Mayo Clinic, Rochester, MN, USA. Electronic address:

Heterotopic ossification(HO) is a common complication following spinal cord injury(SCI); however, its underlying pathophysiology remains relatively unknown. Although there are options for treating HO, prophylactic treatment is limited. Additionally, evidence supporting the effectiveness of these prophylactic treatments is scarce. Read More

J Wound Care 2020 Mar;29(Sup3):S30-S32

1 Department of Plastic Surgery, University of Tennessee Health Science Center, Memphis, US.

Objective: Heterotopic ossification is the formation of ectopic bone in soft tissues. It has three established aetiologies: genetic, traumatic and neurogenic. A gossypiboma is defined as a retained foreign body, such as a mass or sponge, usually after a surgical procedure. Read More

World Neurosurg 2020 Mar;135:377-378

Division of Neurosurgery, Department of Surgery, University of Toronto, Toronto, Ontario, Canada; Division of Neurosurgery, Spinal Program, Toronto Western Hospital, University Health Network, Toronto, Ontario, Canada.

J Musculoskelet Neuronal Interact 2020 03;20(1):160-164

Demiroglu Bilim University Medical Faculty, Physical Medicine and Rehabilitation Department, Istanbul, Turkey.

Neurogenic heterotopic ossification (NHO) is an abnormal development of bone in extra-skeletal tissues, related to neurological disease. NHO is frequently seen after traumatic brain injury or spinal cord injury. NHO may also occur as a rare complication of Guillain Barre Syndrome (GBS). Read More