Ann Rehabil Med.  2016 Dec;40(6):1135-1139. 10.5535/arm.2016.40.6.1135.

Effects of Radiation Therapy on Established Neurogenic Heterotopic Ossification

• Lee CH
• Shim SJ
• Kim HJ
• Yang H
• Kang YJ

• KMID: 2371348
• DOI: http://doi.org/10.5535/arm.2016.40.6.1135

Abstract

Heterotopic ossification (HO) is frequently seen on rehabilitation units after spinal cord injuries, fractures, brain injuries, and limb amputations. Currently, there is no effective treatment for HO other than prophylaxis with anti-inflammatory medications, irradiation, and bisphosphonate administration. These prophylactic treatments are not effective for managing ectopic bone once it has formed. Here we describe three cases of established neurogenic HO treated with radiation therapy (RT). All patients had decreased serum alkaline phosphatase (ALP) and bone-specific ALP levels with decreased pain but increased range of motion immediately after RT. Post-treatment X-rays revealed no further growth of the HO. All patients maintained clinical and laboratory improvements 4 or 6 months after the RT. Our results suggest that RT is safe and effective in decreasing pain and activity of neurogenic HO.

Keyword

Brain injuries; Heterotopic ossification; Radiotherapy

MeSH Terms

Alkaline Phosphatase
Amputation
Brain Injuries
Extremities
Humans
Ossification, Heterotopic*
Radiotherapy
Range of Motion, Articular
Rehabilitation
Spinal Cord Injuries
Alkaline Phosphatase

Figure

• 

  Fig. 1 (A) Gradient recalled echo brain magnetic resonance imaging (MRI) in case 1 showing a dark signal intensity at the gray/white matter interfaces in the bilateral superior frontal gyri suggestive of diffuse axonal injury. In case 2, brain MRI showing an enhancing mass at the falx (B) and in the parietal area with a cerebrospinal fluid cleft suggestive of extra-axial meningioma (C). (D) In case 3, brain computed tomography showing an intracerebral hemorrhage in the right basal ganglia and an intraventricular hemorrhage.

• 

  Fig. 2 In case 1, AP radiographs of the right hip (A) and both knees showing HO (B). Whole body bone scan showing increased uptake at the right hip and both knees (C). (D) In case 2, AP radiographs of both hips showing HO. In case 3, AP radiograph of the left hip (E) and lateral radiograph of the left knee showing HO (F). Whole body bone scan showing increased uptake at the left hip and knee (G). AP, anteroposterior; HO, heterotopic ossification.

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  Fig. 3 (A) Serum alkaline phosphatase (ALP) and (B) bone-specific alkaline phosphatase (BALP) levels are dramatically decreased immediately after radiation therapy (RT) in all three cases. These values remained low or decreased further throughout the follow-up period. Dx, the time of the initial diagnosis of heterotopic ossification.

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