A systematic review of the therapeutic interventions for heterotopic ossification after spinal cord injury

• Published in: Spinal cord Vol. 48; no. 7; pp. 512 - 521
• Main Authors: Teasell, R W, Mehta, S, Aubut, J L, Ashe, M C, Sequeira, K, Macaluso, S, Tu, L
• Format: Journal Article
• Language: English
• Published: London Nature Publishing Group UK 01-07-2010; Nature Publishing Group
• Subjects: 631/378/1687/1825; 631/92/436/108; 692/1807; 692/700/565; Anatomy; Biological and medical sciences; Biomedical and Life Sciences; Biomedicine; Cerebrospinal fluid. Meninges. Spinal cord; Databases, Bibliographic - statistics & numerical data; Human Physiology; Humans; Injuries of the nervous system and the skull. Diseases due to physical agents; Medical sciences; Nervous system (semeiology, syndromes); Neurochemistry; Neurology; Neuropsychology; Neurosciences; Ossification, Heterotopic - etiology; Ossification, Heterotopic - prevention & control; Randomized Controlled Trials as Topic; review; Spinal Cord Injuries - complications; Spinal Cord Injuries - therapy; Traumas. Diseases due to physical agents; spinal cord injury; therapeutic interventions; HO; Nervous system diseases; Treatment; Vertebral canal; Spinal cord trauma; Central nervous system disease; Heterotopic; Spinal cord disease; Ossification
• ISSN: 1362-4393; 1476-5624
• DOI: 10.1038/sc.2009.175

Study design:
Systematic review.
Objective:
To conduct a systematic review of the effectiveness of interventions used to prevent and treat heterotopic ossification (HO) after spinal cord injury (SCI).
Setting:
St Joseph's Parkwood Hospital, London, Ontario, Canada.
Methods:
MEDLINE, CINAHL, EMBASE and PsycINFO databases were searched for articles addressing the treatment of HO after SCI. Studies were selected by two reviewers and were only included for analysis if at least 50% of the subjects had an SCI, there were at least three SCI subjects and if the study subjects participated in a treatment or intervention. Study quality was assessed by two independent reviewers using the Downs and Black evaluation tool for all studies, as well as the PEDro assessment scale for randomized control trials only. Levels of evidence were assigned using a modified Sackett scale.
Results:
A total of 13 studies met the inclusion criteria. The selected articles were divided into prevention or treatment of post-SCI HO. Nonsteroidal anti-inflammatory drugs (NSAIDs), warfarin, and pulse low-intensity electrogmagnetic field (PLIMF) therapy were reviewed as prophylactic measures. Bisphosphonates, radiotherapy and excision were reviewed as treatments of post-SCI HO.
Conclusions:
Pharmacological treatments of HO after SCI had the highest level of research evidence supporting their use. Of these, NSAIDs showed greatest efficacy in the prevention of HO when administered early after an SCI, whereas bisphosphonates were the intervention with strongest supportive evidence once HO had developed. Of the non-pharmacological interventions, PLIMF was supported by the highest level of evidence; however, more research is needed to fully understand its role.