Summary

There is strong Level 1a evidence (from two RCTs: Banovac et al. 2001; Banovac et al. 2004) and level 3 evidence (from one case control study: Zakrasek et al., 2019) that non-steroidal anti-inflammatory medications can reduce the incidence of heterotopic ossification when administered early after a spinal cord injury.

There is Level 5 evidence (from one observational study: Buschbacher et al. 1992) that Warfarin inhibits the development of heterotopic ossification post spinal cord injury.

There is conflicting Level 2 evidence (from two prospective controlled trials: Banovac et al. 1993; Banovac et al. 1997) and Level 4 evidence (from one case series: Branovac 2000) that Etidronate can stop the progression of heterotopic ossification once the diagnosis is made and prevent further HO sites.

There is level 2 evidence (from one prospective controlled trial: Ploumis et al. 2015) that Alendronate does not inhibit the development of heterotopic ossification and in fact, may contribute to the development of contractures.

There is Level 2 evidence (from one prospective controlled trial: Banovac et al. 1997) that Etidronate is not effective once radiographs are positive for HO.

There is Level 4 evidence (from one case series: Schuetz et al. 2005) that pamidronate effectively halts secondary HO progression after surgical resection of HO.

There is Level 1b evidence (from one RCT: Durovic et al. 2009) that Pulse Low-Intensity Electromagnetic Field therapy is effective prophylaxis of HO post-SCI

There is level 3 evidence (from one case control study: Honore et al. 2020) that combining radiotherapy with surgery in patients with hip HO undergoing excision may not prevent HO recurrence and may be associated with an increased risk of postoperative sepsis.

There is moderate Level 4 evidence (from three case series studies: Sautter-Bihl et al. 2000; Sautter-Bihl et al. 2001; Museler et al. 2017) that radiotherapy reduces the progression and recurrence of heterotopic ossification.

There is level 3 evidence (from one case control study: Hollenberg & Mesfin, 2020) that patients with SCI complicated by OPLL may have worse preoperative and postoperative motor function compared to patients with CM and OPLL.

There is level 4 evidence (from four case series: Genet et al. 2011; Garland & Orwin 1989; Meiners et al. 1997; Yang et al. 2017) that resection of HO about the hip post-SCI can dramatically improve restricted hip range of motion; however, post-surgical recurrence and complications are a concern for this treatment.

There is Level 4 evidence (from one case series: Schuetz et al. 2005) that surgical resection combined with pamidronate treatment effectively halts secondary HO progression.

There is level 4 evidence (from one case series: Subbarao et al. 1987) that surgical resection combined with etidronate treatment improves independence with wheelchair use but contributes to reduced range of motion.