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Review
. 2023 Jul 17;31(3):e267451.
doi: 10.1590/1413-785220233103e267451. eCollection 2023.

HETEROTOPIC OSSIFICATION AFTER SPINAL CORD INJURY: PREVENTION AND TREATMENT - A SISTEMATIC REVIEW

Cindy Yukie Nakano Schincariol  1 , Eduardo Martin Insfrán Echauri  1 , Orcizo Francisco Silvestre  1 , Alberto Cliquet  1
Affiliations
Review

HETEROTOPIC OSSIFICATION AFTER SPINAL CORD INJURY: PREVENTION AND TREATMENT - A SISTEMATIC REVIEW

Cindy Yukie Nakano Schincariol et al. Acta Ortop Bras. .

Abstract
in English, Portuguese

Trauma configures the main cause of spinal cord injuries. Patients with traumatic spinal cord injury often develop severe and debilitating outcomes that require multidisciplinary care to adapt patients to their new reality. Heterotopic ossification (HO) is one of the frequent comorbidities in these patients but it still lacks well-established treatments or a gold standard one. Thus, this systematic review aimed to search the current literature for HO treatment and prevention. This study was conducted following PRISMA recommendations (Preferred Reporting Items for Systematic Reviews and Meta-Analysis) and searches were conducted in three databases (PubMed, Embase, and Web of Science). A total of 193 articles were found in an initial search. After screening following the established criteria, eight articles were included in this review; of these, two reported prevention and the others, treatments. Based on data analysis, the use of non-steroidal anti-inflammatory drugs in the acute post-traumatic period proved to be the best method of prevention. In cases of mature HO or accompanied by ankylosis, surgical resection proved to be the most effective treatment despite the high rate of postoperative infections. Level of Evidence III, Systematic Review.

A principal causa de lesão medular é o trauma. O paciente com trauma raquimedular frequentemente evolui com incapacidades graves e debilitantes, fazendo com que necessite de cuidado multiprofissional para se adaptar a uma nova realidade. A ossificação heterotópica (OH) é uma comorbidade comum nesses pacientes, mas que ainda não tem tratamentos bem estabelecidos ou considerados padrão-ouro. Esta revisão sistemática teve como objetivo buscar formas de tratamento e prevenção da OH na literatura atual. O estudo seguiu a recomendação Principais Itens para Relatar Revisões Sistemáticas e Meta-Análises (PRISMA) e realizou buscas em três bases de literatura (PubMed, Embase e Web of Science). Foram encontrados 193 artigos inicialmente, e, após triagem considerando os critérios estabelecidos, oito foram eleitos para o trabalho final. Dois trabalhos abordaram a prevenção; e os demais, tratamentos. Pela análise dos dados, o uso de anti-inflamatórios não esteroidais (AINEs) no período agudo pós-traumático se mostrou como o melhor método de prevenção. Já em relação ao tratamento, nos casos de OH maduras ou com anquilose, a ressecção cirúrgica revelou-se como o método mais efetivo, a despeito da grande taxa de infecção pós-operatória. Nível de Evidência III, Revisão Sistemática.

Keywords: Ossification, Heterotopic; Spinal Cord Injuries; Therapeutics.

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Conflict of interest statement

All authors declare no potential conflict of interest related to this article.

Figures

Figure 1
Figure 1. Flowchart.
HO: heterotopic ossification.
Figure 2
Figure 2. Outcome by intervention.
RT: radiotherapy; NSAIDs: non-steroidal anti-inflammatory drugs.
See this image and copyright information in PMC

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