Recurrence of neurogenic heterotopic ossification after surgical excision and preventive strategies: A systematic review and meta-analysis.

Abstract

Objectives: Neurogenic heterotopic ossification (NHO) is extra-skeletal bone formation induced by neurologic conditions such as spinal cord injury (SCI) and traumatic brain injury (TBI). The definite treatment of established NHO is surgery and the most common complication of surgery is recurrence. This study compared three common postsurgical tertiary prevention strategies: radiotherapy, pharmacological treatment, and no additional intervention.

Materials and methods: Comprehensive searches on PubMed, Embase, Web of Science, and Cochrane Library were conducted until June 2023. Studies' quality was assessed using the MINORS tool, and the rate of NHO recurrence was pooled and compared through random-effects meta-analysis (Dersimonian-Laird). Inclusion criteria involved patients who underwent NHO removal surgery with subcategories based on recurrence prevention strategy: pharmacologic, radiotherapy, and no additional treatment.

Results: In total, 18 studies (n = 937 subjects) were included. Overall prevalence of recurrence (95% CI) was 12.40% (7.49%, 19.82%) with pharmacologic therapy at 9.34% (2.26%, 31.43%), radiotherapy at 15.71% (8.92%, 26.19%), and no additional treatment at 13.55% (6.73%, 25.39%). While no significant differences were observed among the interventions (P > 0.05), pharmacologic therapy exhibited a trend as the most effective method, followed by radiotherapy and no additional treatment.

Conclusion: This study found no significant differences in recurrence rates among treatment groups but noted fewer NHO recurrences with combined pharmacology and surgery in recent studies (after 2000), suggesting potential efficacy of postoperative pharmacotherapy for high-risk patients, though limitations like non-controlled studies and heterogeneity warrant caution.