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Sciatic nerve compression by neurogenic heterotopic ossification: use of CT to determine surgical indications

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Abstract

Objective

To describe the characteristics of neurogenic heterotopic ossification (NHO) based on clinical tests, electroneuromyography (ENMG) and CT in a database of patients with lesions of the central nervous system who required sciatic nerve neurolysis along with posterior hip NHO resection, and to determine the respective roles of ENMG and CT in the management of posterior hip NHOs in patients who are unable to communicate or express pain.

Methods

The consistency of the ENMG results with clinical findings, CT results and macroscopic signs of lesions was retrospectively assessed after sciatic nerve neurolysis and ablation of 55 posterior hip NHOs.

Results

Sciatic nerve neurolysis was necessary in 55 cases (47.4 %; 55 out of 116). CT showed contact of the NHO with the nerve in all cases: 5 in contact with no deflection, 3 in contact with deflection, 21 moulded into a gutter and 26 entrapped in the NHO. There were clinical signs of sciatic nerve lesion in 21.8 % of cases (12 out of 55). ENMG showed signs of sciatic nerve lesions in only 55.6 % (10 out of 18), only 4 of whom presented with clinical signs of a nerve lesion. No significant relationship was found between clinical symptoms and ENMG findings of sciatic nerve compression (n = 13, p = 0.77).

Conclusion

Nerve compression by NHO is likely an underdiagnosed condition, particularly in patients who are unable to communicate. Diagnosis of sciatic compression by NHO should be based on regular clinical examinations and CT. ENMG is not sufficiently sensitive to be used alone for surgical decision-making.

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Authors and Affiliations

  1. Department of Physical Medicine and Rehabilitation, Hôpital Raymond Poincaré, APHP, CIC-IT 805, 104 bd Raymond Poincaré, 92380, Garches, France

    Marjorie Salga, Claire Jourdan & François Genêt

  2. Université de Versailles Saint Quentin en Yvelines, Handi-Resp, (EA4047), Versailles, France

    Claire Jourdan

  3. Department of Neurophysiology, Hôpital Raymond Poincaré, APHP, CIC-IT 805, 104 bd Raymond Poincaré, 92380, Garches, France

    Marie-Christine Durand

  4. Groupement de Recherche Clinique et Technologique sur le Handicap (GRCTH, EA 4497), Université de Versailles Saint Quentin en Yvelines, Versailles, France

    Marie-Christine Durand, Philippe Denormandie & François Genêt

  5. Department of Medical Imaging, Hôpital Raymond Poincaré, APHP, CIC-IT 805, 104 bd Raymond Poincaré, 92380, Garches, France

    Chloé Hangard & Robert-Yves Carlier

  6. Department of Orthopaedic Surgery, Hôpital Raymond Poincaré, APHP, CIC-IT 805, 104 bd Raymond Poincaré, 92380, Garches, France

    Philippe Denormandie

  7. Department of Physical Medicine and Rehabilitation, Military Medical Service, Hôpital d’Instruction des Armées Percy, 101 av Henri Barbusse, 92140, Clamart, France

    François Genêt

Authors
  1. Marjorie Salga
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  2. Claire Jourdan
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  3. Marie-Christine Durand
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  4. Chloé Hangard
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  5. Philippe Denormandie
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  6. Robert-Yves Carlier
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  7. François Genêt
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Correspondence to François Genêt.

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Salga, M., Jourdan, C., Durand, MC. et al. Sciatic nerve compression by neurogenic heterotopic ossification: use of CT to determine surgical indications. Skeletal Radiol 44, 233–240 (2015). https://doi.org/10.1007/s00256-014-2003-6

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  • DOI: https://doi.org/10.1007/s00256-014-2003-6

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