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At least 1,243 records · Page 69Linked to original sources
PubMed2004

Radiotherapy vs. nonsteroidal anti-inflammatory drugs for the prevention of heterotopic ossification after major hip procedures: a meta-analysis of randomized trials.

PURPOSE: To evaluate the efficacy of radiotherapy (RT) vs. nonsteroidal anti-inflammatory drugs (NSAIDs) in the prevention of heterotopic ossification (HO) after major hip procedures. METHODS AND MATERIALS: We conducted a meta-analysis of 7 randomized studies (n = 1143) comparing RT with NSAIDs. Data were combined across studies using fixed and random effects models. We conducted separate analyses for clinically significant HO (Brooker Grade 3 and 4) and for any HO (any Brooker grade). RESULTS: Overall RT tended to be more effective than NSAIDs in preventing Brooker 3 or 4 HO (risk ratio, 0.42; 95% confidence interval [CI], 0.18-0.97) or any HO (risk ratio, 0.75; 95% CI, 0.37-1.71), but with significant between-study heterogeneity for the second analysis. The overall absolute risk difference for Brooker 3 or 4 HO was small (-1.18%; 95% CI, -2.45% to 0.09%). Subgroup analyses showed that early preoperative RT (16-20 hours before surgery) and acetylsalicylic acid were less effective. For postoperative RT, there was a significant dose-response relationship (p = 0.008): 6 Gy of RT was equally effective as NSAIDs, whereas increasing radiation doses were more effective. CONCLUSIONS: Although absolute differences may be small, postoperative RT is on average more effective than NSAIDs in preventing HO after major hip procedures, and its efficacy is dose dependent.

Anti-Inflammatory Agents, Non-Steroidal↗
PubMed2006

Heterotopic ossification: Pathophysiology, clinical features, and the role of radiotherapy for prophylaxis.

Heterotopic ossification (HO) is a benign condition of abnormal formation of bone in soft tissue. HO is frequently asymptomatic, though when it is more severe it typically manifests as decreased range of motion at a nearby joint. HO has been recognized to occur in three distinct contexts-trauma, neurologic injury, and genetic abnormalities. The etiology of HO is incompletely understood. A posited theory is that HO results from the presence of osteoprogenitor cells pathologically induced by an imbalance in local or systemic factors. Individuals at high risk for HO development frequently undergo prophylaxis to prevent HO formation. The two most commonly employed modalities for prophylaxis are nonsteroidal anti-inflammatory drugs and radiation therapy. This review discusses HO pathophysiology, clinical features, and the role of radiotherapy for prophylaxis.

Anti-Inflammatory Agents, Non-Steroidal↗
PubMedDate not supplied

Hysteroscopic diagnosis and treatment of endocervical ossification: a case report.

We describe a case of osseous metaplasia into the cervical canal in a 41-year-old woman. The patient had a history of primary infertility, pelvic pain, chronic endocervicitis, and bone formation in the upper third of the cervical canal. After antibiotic therapy, we removed bone fragments by operative hysteroscopy using grasping forceps. The fragments were completely removed with no evidence of recurrence at 1-year follow-up. Chronic endocervicitis may cause endocervical ossification and should be ruled out before surgical removal of bone fragments in order to ensure definitive resolution and prevent recurrence.

Adult↗
PubMed2006

Cord compression secondary to intradural ossification.

The authors describe two patients presenting with a previous history of spinal trauma and a several-year history of sensory changes secondary to spinal cord compression. Both patients underwent laminectomy and spinal decompression operations. In both cases intradural bone causing neural compression was removed at operation. Potential mechanisms to explain intradural ossification and the relevant literature are reviewed.

Adult↗
PubMedDate not supplied

Heterotopic ossification after primary shoulder arthroplasty.

We have assessed the incidence of heterotopic ossification (HO) after primary shoulder joint replacement in 126 shoulders; 58 patients had hemiarthroplasty, and 68 had total shoulder joint replacement. HO developed to a minor extent in 15% of patients (19/126). There was no statistical difference between hemiarthroplasty or total shoulder replacement or between male and female patients. Patients with cuff tear arthropathy were the only group with an increased risk (36.4% [4/11]) of having HO develop. In patients with osteoarthritis, fractures, or rheumatoid arthritis, HO occurred in less than 14.5% (15/115). Nonsteroidal anti-inflammatory drugs (NSAIDs) did not appear to have any effect on HO as in hip replacement, as HO developed in 15.15% of patients having NSAIDs postoperatively and in 15.05% of patients without NSAIDs. Prophylaxis of HO with NSAIDs seems only to be indicated in patients with cuff tear arthropathy.

Adult↗
PubMed2004

Spinal canal size in ossification of the posterior longitudinal ligament of the cervical spine.

BACKGROUND: The size of the spinal canal is a factor that contributes to the neurologic deficits associated with cervical ossification of the posterior longitudinal ligament (OPLL). METHODS: Bone-window computed tomography (CT) examinations of the cervical spine in 64 patients with cervical OPLL were reviewed. Forty-two patients underwent surgical treatment (anterior decompression: 16 patients, posterior decompression: 26 patients). The remaining 22 patients were managed conservatively. Selection of the surgical approach, anterior or posterior, was based on the longitudinal extent of cord compression. RESULTS: The mean developmental size of the spinal canal in the posterior decompression group (10.7 mm at C4) was significantly smaller than the other 2 groups. The spinal canal was narrowed by OPLL to 2.9 to 10.0 mm. The proportion of the patients showing motor deficits of the lower extremities significantly increased when the sagittal canal diameter was narrowed to less than 8 mm. CONCLUSIONS: This study demonstrates critical values of CT-determined spinal canal stenosis. Developmental size of the spinal canal and the residual anterior-posterior canal diameters resulting from OPLL spinal cord compression are important factors influencing clinical management and the neurologic state.

Adult↗
PubMed1994

Endometrial ossification: a cause of secondary infertility. Report of two cases.

Two cases of endometrial ossification with secondary infertility are reported; pelvic ultrasonography suggested an intrauterine foreign body in one case. Hysteroscopy was necessary to make the correct diagnosis and to remove the bony fragments from the two cases. One patient conceived naturally after the bony fragments were removed.

Abortion, Induced↗
PubMed2001

Stenosis of the trachea caused by retrosternal ossification.

An abnormal anatomic structure of the thoracic inlet causing stenosis of the trachea is rare. This case report illustrates a man presenting tracheal stenosis caused by retrosternal ossification, and discusses its clinical significance and possible pathogenesis.

Humans↗
PubMed1997

Prostaglandin E2 measurements: their value in the early diagnosis of heterotopic ossification in spinal cord injury patients.

OBJECTIVE: To look for a possible relation between the occurrence of heterotopic ossification (HO) and the modifications of the 24-hour prostaglandin E2 (PGE2) urinary excretion. DESIGN: A 5-year prospective study to determine the 24-hour urinary excretion of PGE2 by radioimmunoassay with specific antisera not cross-reacting with TXA2, TXB2, 15-keto-PGE2 alpha, PGI2, 6-keto-PGF1 alpha. SETTING: The laboratory of a division of endocrinology and diabetology of a university hospital. PATIENTS: Of 262 acute spinal cord injury patients screened, 44 were eligible for the study. INTERVENTIONS: Serial diagnostic quantitative bone scannings with technetium 99m Tc methylene diphosphate (99mTc-MDP) and therapeutic assessment of radiotherapy and indomethacin. MEAN OUTCOME MEASURE: Hypothetical increase of PGE2 before and during HO formation. RESULTS: Of 44 patients, 8 developed an HO (18.8%) with concomitant marked increase of the PGE2 excretion for as long as the HO had not reached maturity. The results of the radiotherapy were inconclusive. Indomethacin was shown to be efficacious in holding back or slowing down the HO evolution. CONCLUSIONS: Measurement of the 24-hour PGE2 urinary excretion appears to be a valuable indicator in the early diagnosis of HO. Indomethacin should be considered as an alternative to other existing therapies.

Acute Disease↗
PubMed1997

Heterotopic ossification as a complication of toxic epidermal necrolysis.

The development of heterotopic ossification (HO) as a complication of toxic epidermal necrolysis (TEN) has not been previously reported. TEN, also known as Lyell's syndrome, is a rare but serious skin disorder that typically occurs after the administration of drugs, especially sulfonamides, barbiturates, phenytoin, and nonsteroidal anti-inflammatory agents. TEN is characterized by the development of large fluid-filled bullae with separation of large sheets of skin. Complications of TEN can include extensive denudation of skin with dehydration and electrolyte abnormalities, gastrointestinal hemorrhage, acute tubular necrosis, secondary infection of denuded skin, pneumonia, bacterial conjunctivitis, keratitis, and septic infarcts of internal organs. We report a case of HO in a patient with TEN after treatment with trimethoprim-sulfamethoxazole. A 49-year-old man developed an erythematous rash, bullae, fever, and extensive skin loss consistent with a diagnosis of TEN. He was intubated for complications of TEN (pneumonia) and maintained on bed rest for several weeks. In addition, he developed HO that resulted in multiple joint contractures. He was treated with aggressive range of motion by physical therapy, surgical resection of the HO followed by radiation to both elbows, right hip, and right knee. Postoperative outpatient rehabilitation enabled improved function in his mobility and activities of daily living. HO is known to occur after spinal cord and brain injuries and burns. It has not been reported to occur after TEN. Our experience with this case suggests that HO may merit inclusion into the list of complications of TEN.

Anti-Infective Agents↗
PubMed1995

Childhood ossification of the anterior longitudinal ligament of the cervical spine.

Two paediatric cases of acquired ossification of the cervical anterior longitudinal ligament are described. This has not been previously reported in childhood. The first was associated with corrosive ingestion requiring oesophagectomy and colonic interposition and the second with acute lymphoblastic leukaemia initially presenting as idiopathic hypereosinophilic syndrome. Possible mechanisms are discussed.

Cervical Vertebrae↗
PubMed1987

Inter-sterno-costo-clavicular ossification.

The clinical and radiological features of four patients with inter-sterno-costo-clavicular ossification are described. The process was associated with established seronegative spondyloarthropathy in three cases of whom four had long standing psoriasis, the other having ankylosing spondylitis. In the fourth case no associated arthropathy was present. A review of the literature is presented.

Adult↗
PubMed1989

Trismus and multifocal soft tissue ossification. A presentation of fibrodysplasia ossificans progressiva?

A 21-year-old female patient presented with trismus, initially diagnosed as related to pericoronitis. Computed tomography demonstrated heterotopic soft tissue ossification involving both medial pterygoids which was later followed by similar features in the submandibular muscles and right quadriceps. A variant of fibrodysplasia ossificans progressiva was considered the likeliest diagnosis. The computed tomographic features of the condition and the importance of early diagnosis are stressed.

Adult↗
PubMed2002

Gluteus minimus necrotic muscle debridement diminishes heterotopic ossification after acetabular fracture fixation.

OBJECTIVE: The aetiology and pathogenesis of heterotopic ossification (HO) are still obscure. We evaluated the impact of necrotic gluteus minimus muscle (GMM) debridement on the formation of HO after operative treatment of posterior wall (PW) and associated transverse-posterior wall acetabular fracture (Tr/PW) fixations utilizing a Kocher-Langenbeck surgical exposure. METHODS: Thirty-one consecutive patients with displaced PW or associated Tr/PW acetabular fracture-dislocations were operatively treated by a single surgeon using a Kocher-Langenbeck surgical exposure. Strict soft tissue technique was observed and self-retaining retractors were not used. Necrotic GMM was debrided in an attempt to diminish ectopic bone formation. RESULTS: Twenty-nine patients were available for post-operative clinical and radiographic evaluations. HO occurred in 12 patients. Significant HO (Brooker class III or IV) was noted in only three patients (10%). There were no complications associated with debridement of necrotic GMM. CONCLUSIONS: Necrotic GMM resection diminishes HO formation comparably to other reported series in which non-steroidal anti-inflammatory medications were used. Resection of the necrotic GMM from the zone of injury has proved to be an efficient and safe method of preventing significant HO in patients after operative fixation of PW and associated Tr/PW acetabular fractures treated through a Kocher-Langenbeck approach.

Acetabulum↗
PubMed1995

Permanent heterotopic ossification at the injection site after diphtheria-tetanus-pertussis immunizations in children who have fibrodysplasia ossificans progressiva.

In patients who have fibrodysplasia ossificans progressiva, routine childhood diphtheria-tetanus-pertussis immunizations administered by intramuscular injection caused a significant risk of permanent heterotopic ossification at the site of injection (p < 10(-8)), whereas measles-mumps-rubella immunizations administered by subcutaneous injection posed no significant risk. Intramuscular injections should be avoided, if possible, once a diagnosis of fibrodysplasia ossificans progressiva has been established.

Adolescent↗
PubMed1976

Ectopic renal ossification as nucleus of urinary stones.

Areas of ectopic ossification were found in thin sections from 19 of 1,624 calculi submitted to a petrographic procedure, an incidence of 1.16 per cent. Only 8 calculi of renal, pelvic or ureteral origin with osseous tissue in its structure have been described since the first report by Phemister in 1923.

Female↗
PubMed2000

Simultaneous cervical diffuse idiopathic skeletal hyperostosis and ossification of the posterior longitudinal ligament resulting in dysphagia or myelopathy in two geriatric North Americans.

BACKGROUND: Cervical diffuse idiopathic skeletal hyperostosis (DISH) and ossification of the posterior longitudinal ligament (OPLL) rarely coexist in the North American population. Here, different surgical strategies were used to manage simultaneous DISH and OPLL resulting in dysphagia or myelopathy in two geriatric patients. METHODS: A 74-year-old male with esophageal compression and dysphagia attributed to DISH, and cord compression with myelopathy due to OPLL, was treated with a cervical laminectomy followed by anterior DISH resection. On the other hand, an 80-year-old male with asymptomatic DISH but moderate myelopathy (Nurick Grade III) secondary to OPLL required only a cervical laminectomy. RESULTS: In the first patient, dysphagia resolved within 3 months of surgery, while in the second individual, myelopathy improved to Nurick Grade I (mild myelopathy) within 6 months postoperatively. Improvement in both patients was maintained 1 year after surgery. CONCLUSIONS: While DISH and OPLL may coexist in geriatric patients, only those with dysphagia should undergo DISH resection, while others demonstrating myelopathy should have laminectomy alone.

Aged↗