Use of radiotherapy in immature heterotopic ossification in patients with spinal cord injury

Authors

  • Luciana Delboni Taricco Associação de Assistência à Criança Deficiente
  • Isolda Ferreira de Araujo Associação de Assistência à Criança Deficiente
  • Yara Juliano Associação de Assistência à Criança Deficiente
  • Marcelo de Jesus Justino Ares Associação de Assistência à Criança Deficiente
  • Adriana Rosa Lovisotto Cristante Associação de Assistência à Criança Deficiente

DOI:

https://doi.org/10.11606/issn.2317-0190.v15i3a102937

Keywords:

Ossification, Heterotopic, Spinal Cord Injuries, Radiotherapy

Abstract

The incidence of heterotopic ossification (HO) in adult patients with spinal cord injuries is roughly 20%. HO usually has a benign development, but can reduce the range of joint motion and hinder the rehabilitation process. Few studies have shown the use of radiotherapy in the treatment of HO in patients with spinal cord injuries. The objective of this study is to assess whether immature heterotopic ossification progresses in patients with spinal cord injuries submitted to radiotherapy as the primary treatment. The medical records of patients attending the spinal cord injury clinic of AACD (Associação de Assistência à Criança Deficiente) with immature HO and who were treated exclusively with radiotherapy were selected. This is a historical cohort-type study. Ossification progress was determined by analysis of the range of motion of the affected joint, measurements with a goniometer and radiographic image. Ossification was classified according to the classification proposed by Brooker et al. The study follow-up period was 23.3 months. Fourteen of the 15 studied joints did not worsen clinically, nor did the HO progress. None of the patients had side effects from radiotherapy. We conclude that patients treated early with radiotherapy do not present significant HO development and that radiotherapy is a safe and easy-to-use method.

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References

Pape HC, Marsh S, Morley JR, Krettek C, Giannoudis PV. Current concepts in the development of heterotopic ossification. J Bone Joint Surg Br. 2004;86(6):783-7.

Shehab D, Elgazzar AH, Collier BD. Heterotopic ossification. J Nucl Med. 2002;43(3):346-53.

Wittenberg RH, Peschke U, Bötel U. Heterotopic ossification after spinal cord injury. Epidemiology and risk factors. J Bone Joint Surg Br. 1992;74(2):215-8.

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.

Garland DE, Shimoyama ST, Lugo C, Barras D, Gilgoff I. Spinal cord insults and heterotopic ossification in the pediatric population. Clin Orthop Relat Res. 1989;(245):303-10.

van Kuijk AA, Geurts AC, van Kuppevelt HJ. Neurogenic heterotopic ossification in spinal cord injury. Spinal Cord. 2002;40(7):313-26.

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

Colachis SC 3rd, Clinchot DM, Venesy D. Neurovascular complications of heterotopic ossification following spinal cord injury. Paraplegia. 1993;31(1):51-7.

Paul SM, Hammerman A, Stoddard E. Heterotopic ossification causing extrinsic compression of the deep venous system of the lower extremity (abstract). Arch Phys Med Rehabil. 1988;69:760.

Riklin C, Baumberger M, Wick L, Michel D, Sauter B, Knecht H. Deep vein thrombosis and heterotopic ossification in spinal cord injury: a 3 year experience at the Swiss Paraplegic Centre Nottwil. Spinal Cord. 2003;41(3):192-8.

Wick L, Berger M, Knecht H, Glücker T, Ledermann HP. Magnetic resonance signal alterations in the acute onset of heterotopic ossification in patients with spinal cord injury. Eur Radiol. 2005;15(9):1867-75.

Kluger G, Kochs A, Holthausen H. Heterotopic ossification in childhood and adolescence. J Child Neurol. 2000;15(6):406-13.

Sautter-Bihl ML, Liebermeister E, Nanassy A. Radiotherapy as a local treatment option for heterotopic ossifications in patients with spinal cord injury. Spinal Cord. 2000;38(1):33-6.

Sautter-Bihl ML, Hültenschmidt B, Liebermeister E, Nanassy A. Fractionated and single-dose radiotherapy for heterotopic bone formation in patients with spinal cord injury. A phase-I/II study. Strahlenther Onkol. 2001;177(4):200-5.

Banovac K, Gonzalez F. Evaluation and management of heterotopic ossification in patients with spinal cord injury. Spinal Cord. 1997;35(3):158-62.

Snoecx M, De Muynck M, Van Laere M. Association between muscle trauma and heterotopic ossification in spinal cord injured patients: reflections on their causal relationship and the diagnostic value of ultrasonography. Paraplegia. 1995;33(8):464-8.

Bodley R, Jamous A, Short D. Ultrasound in the early diagnosis of heterotopic ossification in patients with spinal injuries. Paraplegia. 1993;31(8):500-6.

Maier D. Heterotopic ossification spinal cord injury. Management through early diagnosis and therapy. Orthopade. 2005;34(2):120-7.

Banovac K, Williams JM, Patrick LD, Levi A. Prevention of heterotopic ossification after spinal cord injury with COX-2 selective inhibitor (rofecoxib). Spinal Cord. 2004;42(12):707-10.

Banovac K, Williams JM, Patrick LD, Haniff YM. Prevention of heterotopic ossification after spinal cord injury with indomethacin. Spinal Cord. 2001;39(7):370-4.

Schuetz P, Mueller B, Christ-Crain M, Dick W, Haas H. Amino-bisphosphonates in heterotopic ossification: first experience in five consecutive cases. Spinal Cord. 2005;43(10):604-10.

Garland DE, Alday B, Venos KG, Vogt JC. Diphosphonate treatment for heterotopic ossification in spinal cord injury patients. Clin Orthop Relat Res. 1983;(176):197-200.

Banovac K, Gonzalez F, Wade N, Bowker JJ.Intravenous disodium etidronate therapy in spinal cord injury patients with heterotopic ossification. Paraplegia. 1993;31(10):660-6.

Balboni TA, Gobezie R, Mamon HJ. Heterotopic ossification: Pathophysiology, clinical features, and the role of radiotherapy for prophylaxis. Int J Radiat Oncol Biol Phys. 2006;65(5):1289-99.

Schaeffer MA, Sosner J. Heterotopic ossification: treatment of established bone with radiation therapy. Arch Phys Med Rehabil. 1995;76(3):284-6.

Brooker AF, Bowerman JW, Robinson RA, Riley LH Jr. Ectopic ossification following total hip replacement. Incidence and a method of classification. J Bone Joint Surg Am. 1973;55(8):1629-32.

Siegel S, Castellan NJ Jr. Nonparametric statistics. 2.ed. New York: McGraw-Hill; 1988.

Published

2008-09-09

Issue

Section

Original Article

How to Cite

1.
Taricco LD, Araujo IF de, Juliano Y, Ares M de JJ, Cristante ARL. Use of radiotherapy in immature heterotopic ossification in patients with spinal cord injury. Acta Fisiátr. [Internet]. 2008 Sep. 9 [cited 2024 May 27];15(3):144-8. Available from: https://www.revistas.usp.br/actafisiatrica/article/view/102937