Heterotopic ossification: diagnosis and management, current concepts and controversies.

HO is a pathologic process in which soft tissues undergo ossification. The etiology is unknown. Patients with neurologic deficits develop HO in the proximal joints. An incidence of 20% to 30% is commonly reported; 8% to 10% of these patients develop severe functional limitations. Routine prophylaxis in patients with SCI cannot be justified. Early diagnosis and treatment with EHDP or other anti-inflammatory medications have been shown to result in good functional outcomes. Elevated SAP levels and positive radionuclide scan, in addition to restriction of joint ROM, are indicative of HO formation. Role of other anti-inflammatories, radiation, and early surgical excision without bone maturity in these patients need to be studied further. A small percentage of patients require surgery to improve function. Joint manipulation to produce pseudoarthrosis is not indicated in patients with SCI.