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Neurogenic heterotopic ossification: epidemiology and morphology on conventional radiographs in an early neurological rehabilitation population

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Abstract

Objective

To retrospectively evaluate neurogenic heterotopic ossification in an early neurological rehabilitation population (phases B and C) with respect to epidemiology and morphology on conventional radiographs.

Materials and methods

Over a 4-year period, 1,463 patients treated at a clinic for early neurological rehabilitation were evaluated for clinical symptoms of neurogenic heterotopic ossification. In case of clinical suspicion, plain radiographs of the expected sites were obtained. If heterotopic ossification was detected, the initial and subsequent radiographs were retrospectively analyzed for sites, size, and morphology. Immature lesions were categorized as small (<10 mm) or large (10–100 mm).

Results

The prevalence rate of neurogenic heterotopic ossification was 2.05%. The condition was most common in young male adults. The hip was the most common site accounting for more than half of the cases. Two or more ossifications were seen in 56.7% of the affected patients with approximately two-thirds showing bilateral symmetric involvement of corresponding joint regions. The size of ossifications strongly varied interindividually. Small immature lesions demonstrated less progression in size than large lesions during maturation (P < 0.05).

Conclusion

Standard radiographs, as a fast and inexpensive technique, allow the expected size progression of heterotopic ossifications during maturation to be estimated, which is relevant in terms of therapeutic decisions, patient mobilization, and neurological rehabilitation.

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References

  1. Guo JJ, Yang HL, Cheung KM, Tang TS, Luk KD. Classification and management of the tandem ossification of the posterior longitudinal ligament and flaval ligament. Chin Med J Engl. 2009;122:219–24.

    PubMed  Google Scholar 

  2. Richards PJ, Braid JC, Carmont MR, Maffulli N. Achilles tendon ossification: pathology, imaging and aetiology. Disabil Rehabil. 2008;30:1651–65.

    Article  PubMed  Google Scholar 

  3. Ahrengart L. Periarticular heterotopic ossification after total hip arthroplasty. Risk factors and consequences. Clin Orthop Relat Res 1991;263:49–58.

    Google Scholar 

  4. Garland DE. Clinical observations on fractures and heterotopic ossification in the spinal cord and traumatic brain injured populations. Clin Orthop Relat Res 1988;233:86–101.

    Google Scholar 

  5. Wittenberg RH, Peschke U, Botel U. Heterotopic ossification after spinal cord injury. Epidemiology and risk factors. J Bone Joint Surg Br. 1992;74:215–8.

    PubMed  CAS  Google Scholar 

  6. Cipriano CA, Pill SG, Keenan MA. Heterotopic ossification following traumatic brain injury and spinal cord injury. J Am Acad Orthop Surg. 2009;17:689–97.

    PubMed  Google Scholar 

  7. Taly AB, Nair KP, Jayakumar PN, et al. Neurogenic heterotopic ossification: a diagnostic and therapeutic challenge in neurorehabilitation. Neurol India. 2001;49:37–40.

    PubMed  CAS  Google Scholar 

  8. Goldberg MA, Schumacher HR. Heterotopic ossification mimicking acute arthritis after neurologic catastrophes. Arch Intern Med. 1977;137:619–21.

    Article  PubMed  CAS  Google Scholar 

  9. Orzel JA, Rudd TG. Heterotopic bone formation: clinical, laboratory, and imaging correlation. J Nucl Med. 1985;26:125–32.

    PubMed  CAS  Google Scholar 

  10. Ragone Jr DJ, Kellerman WC, Bonner Jr FJ. Heterotopic ossification masquerading as deep venous thrombosis in head-injured adult: complications of anticoagulation. Arch Phys Med Rehabil. 1986;67:339–41.

    PubMed  Google Scholar 

  11. Sarafis KA, Karatzas GD, Yotis CL. Ankylosed hips caused by heterotopic ossification after traumatic brain injury: a difficult problem. J Trauma. 1999;46:104–9.

    Article  PubMed  CAS  Google Scholar 

  12. Wharton GW, Morgan TH. Ankylosis in the paralyzed patient. J Bone Joint Surg Am. 1970;52:105–12.

    PubMed  CAS  Google Scholar 

  13. Garland DE. A clinical perspective on common forms of acquired heterotopic ossification. Clin Orthop Relat Res 1991;263:13–29.

    Google Scholar 

  14. Damanski M. Heterotopic ossifications in paraplegia: a clinical study. J Bone Joint Surg Br. 1961;43:286–99.

    Google Scholar 

  15. McCarthy EF, Sundaram M. Heterotopic ossification: a review. Skeletal Radiol. 2005;34:609–19.

    Article  PubMed  CAS  Google Scholar 

  16. Kransdorf MJ, Meis JM, Jelinek JS. Myositis ossificans: MR appearance with radiologic-pathologic correlation. AJR Am J Roentgenol. 1991;157:1243–8.

    PubMed  CAS  Google Scholar 

  17. Kramer FL, Kurtz AB, Rubin C, Goldberg BB. Ultrasound appearance of myositis ossificans. Skeletal Radiol. 1979;4:19–20.

    Article  PubMed  CAS  Google Scholar 

  18. McAteer EJ, Hallam LA, Hendry GM. Ultrasonic appearances of the early changes in fibrodysplasia ossificans progressiva. Br J Radiol. 1990;63:809–12.

    Article  PubMed  CAS  Google Scholar 

  19. Popken F, Konig DP, Tantow M, Rutt J, Kausch T, Peters KM. Possibility of sonographic early diagnosis of heterotopic ossifications after total hip-replacement. Unfallchirurg. 2003;106:28–31.

    Article  PubMed  CAS  Google Scholar 

  20. De Smet AA, Norris MA, Fisher DR. Magnetic resonance imaging of myositis ossificans: analysis of seven cases. Skeletal Radiol. 1992;21:503–7.

    PubMed  Google Scholar 

  21. Shirkhoda A, Armin AR, Bis KG, Makris J, Irwin RB, Shetty AN. MR imaging of myositis ossificans: variable patterns at different stages. J Magn Reson Imaging. 1995;5:287–92.

    Article  PubMed  CAS  Google Scholar 

  22. Banovac K, Gonzalez F. Evaluation and management of heterotopic ossification in patients with spinal cord injury. Spinal Cord. 1997;35:158–62.

    Article  PubMed  CAS  Google Scholar 

  23. Garland DE, Orwin JF. Resection of heterotopic ossification in patients with spinal cord injuries. Clin Orthop Relat Res 1989;242:169–76.

    Google Scholar 

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Authors and Affiliations

  1. Institut für Diagnostische Radiologie und Neuroradiologie, Ernst Moritz Arndt Universität Greifswald, Ferdinand-Sauerbruch-Straße, 17487, Greifswald, Germany

    R. Seipel, S. Langner, M. Lippa, J. P. Kuehn & N. Hosten

  2. BDH-Klinik Greifswald GmbH, Neurologisches Rehabilitationszentrum und Querschnittgelähmtenzentrum, An-Institut der Ernst-Moritz-Arndt-Universität, Karl-Liebknecht-Ring 26a, 17491, Greifswald, Germany

    T. Platz

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  1. R. Seipel
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  2. S. Langner
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  3. T. Platz
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  4. M. Lippa
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  5. J. P. Kuehn
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  6. N. Hosten
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Correspondence to S. Langner.

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Seipel, R., Langner, S., Platz, T. et al. Neurogenic heterotopic ossification: epidemiology and morphology on conventional radiographs in an early neurological rehabilitation population. Skeletal Radiol 41, 61–66 (2012). https://doi.org/10.1007/s00256-011-1115-5

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  • DOI: https://doi.org/10.1007/s00256-011-1115-5

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