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Dural ossification — Clinical Guidelines

Overview

Heterotopic ossification (HO) refers to the abnormal formation of bone in soft tissues, often following trauma or surgery, leading to functional impairment and pain 1 3.

Diagnosis

Clinical Presentation: Pain, stiffness, and limited range of motion 2 5.

Imaging: Radiographs and MRI are crucial for diagnosis, confirming ectopic bone formation 2 5.

Grading: Various grading systems exist but are not uniformly detailed in provided abstracts 3.

Management

Conservative Treatment: Physiotherapy and nonsteroidal anti-inflammatory drugs (NSAIDs) for mild cases 2 5.

Surgical Excision: Indicated for severe cases causing significant functional impairment 2 6.

Radiotherapy: Prophylactic or symptomatic management, particularly effective for pain relief 6.

Prophylactic Measures: Limited evidence; ongoing research focuses on prevention strategies 1 3.

Special Populations

Elderly: Higher risk of complications and slower recovery; careful monitoring advised 4 5.

Comorbidities: Presence of comorbidities may complicate management and recovery 4.

Key Recommendations

Use NSAIDs and physiotherapy for initial management of symptomatic HO (Evidence: Moderate 2 5).

Consider surgical excision for severe cases with significant functional impairment (Evidence: Weak 2 6).

Evaluate prophylactic radiotherapy for symptomatic relief in advanced HO cases (Evidence: Moderate 6).

Monitor elderly patients closely due to increased risk of complications (Evidence: Expert opinion 4 5).

References

1 Kazarian GS, Cecere R, Sheha E, Dowdell J, Iyer S, Qureshi S. The Impact of Endplate Coverage on Heterotopic Ossification Following Cervical Disc Replacement: A Systematic Review and Meta Analysis. Spine 2024. link 2 Dhollander O, McKee A, Houben R. Severe heterotopic ossification after a shoulder arthroscopy : a rare clinical presentation. Acta orthopaedica Belgica 2020. link 3 Mujtaba B, Taher A, Fiala MJ, Nassar S, Madewell JE, Hanafy AK et al.. Heterotopic ossification: radiological and pathological review. Radiology and oncology 2019. link 4 Anastasiu M, Dedu R, Vicol D, Popescu D. An unexpected complication of a heterotopic ossified abdominal scar. Annali italiani di chirurgia 2018. link 5 Patel P, Brkljac M, Sonar U, Kumar S. Heterotopic ossification following anterior shoulder dislocation. BMJ case reports 2018. link 6 Tao MJ, Probyn L, Poon M, Kreder H, Wan BA, Diaz P et al.. Symptomatic palliation with radiotherapy in extensive heterotopic ossifications. Annals of palliative medicine 2017. link 7 Paech MJ, Doherty DA, Christmas T, Wong CA. The volume of blood for epidural blood patch in obstetrics: a randomized, blinded clinical trial. Anesthesia and analgesia 2011. link 8 Gofton WT, King GJ. Heterotopic ossification following elbow arthroscopy. Arthroscopy : the journal of arthroscopic & related surgery : official publication of the Arthroscopy Association of North America and the International Arthroscopy Association 2001. link

Dural ossification