BACKGROUND/AIM: Mobilisation of patients with paraplegia is frequently associated with acute inflammatory processes of soft tissues and muscles in the neighbourhood of joints, where subsequently heterotopic bone formation develops. Rehabilitation is then seriously compromised. For this clinical situation, no local therapeutic options exist so far except extensive resection. To evaluate if radiotherapy early in the course of the disease prevents heterotopic bone formation or if--in case of already manifest ossification and consecutive resection--recurrence can be avoided. PATIENTS AND METHODS: In 20 patients with paralysis, 25 regions were irradiated with (mostly) 10 Gy in single fractions of 2 to 2.5 Gy using 8 MV photons. In 15 patients radiotherapy was performed as a primary treatment in the status of myositis; 7 patients were treated after (subtotal) resection of already manifest ossifications (2 patients were treated twice, primarily and postoperatively). RESULTS: In a minimum follow-up of 12 weeks, none of the 20 irradiated patients showed any progression of the developing or already manifest ossification; thus mobilisation and rehabilitation could be carried out as desired. No side effects occurred. CONCLUSION: The preliminary results of the present study suggest that radiotherapy is an effective local treatment with minimal side effects for the prevention of heterotopic bone formation in patients with paraplegia. Treatment should be started early in the course of the disease. Further evaluation in a prospective study seems desirable.
BACKGROUND/AIM: Mobilisation of patients with paraplegia is frequently associated with acute inflammatory processes of soft tissues and muscles in the neighbourhood of joints, where subsequently heterotopic bone formation develops. Rehabilitation is then seriously compromised. For this clinical situation, no local therapeutic options exist so far except extensive resection. To evaluate if radiotherapy early in the course of the disease prevents heterotopic bone formation or if--in case of already manifest ossification and consecutive resection--recurrence can be avoided. PATIENTS AND METHODS: In 20 patients with paralysis, 25 regions were irradiated with (mostly) 10 Gy in single fractions of 2 to 2.5 Gy using 8 MV photons. In 15 patients radiotherapy was performed as a primary treatment in the status of myositis; 7 patients were treated after (subtotal) resection of already manifest ossifications (2 patients were treated twice, primarily and postoperatively). RESULTS: In a minimum follow-up of 12 weeks, none of the 20 irradiated patients showed any progression of the developing or already manifest ossification; thus mobilisation and rehabilitation could be carried out as desired. No side effects occurred. CONCLUSION: The preliminary results of the present study suggest that radiotherapy is an effective local treatment with minimal side effects for the prevention of heterotopic bone formation in patients with paraplegia. Treatment should be started early in the course of the disease. Further evaluation in a prospective study seems desirable.
Authors: Mustafa Citak; Eduardo M Suero; Manuel Backhaus; Renate Meindl; Thomas A Schildhauer Journal: Eur Spine J Date: 2012-02-04 Impact factor: 3.134
Authors: M Citak; D Grasmücke; O Cruciger; M Königshausen; R Meindl; T A Schildhauer; M Aach Journal: Spinal Cord Date: 2015-10-27 Impact factor: 2.772