Best Practice for Heterotopic Ossification Prevention and Management
1Crew J, 2Hastings J
1Santa Clara Valley Medical Center, San Jose, California, United states; 2University of Puget Sound, Tacoma, Washington, United states
The prevalence of HO from a Santa Clara Valley Medical Center (SCVMC) internal database suggests that it represents a significant comorbidity of acute SCI:
· Nontraumatic SCI: 9/92 (9.8%) had HO
· Traumatic SCI: 43/189 (22.8%) had HO
· Of those with Traumatic SCI and HO, 38/43 (88%) had complete neurological injury.
In order to frame the panel discussion, a case example of joint ankylosis in a young SCI patient resulting in poor WC positioning complicated subsequently by sacral pressure sore formation and autonomic dysreflexia will be presented to illustrate the multidisciplinary complexity of HO. The session will then focus on minimizing HO risk and optimizing HO management within the SCI team (physician, PT, OT, SCI-specific seating clinic, etc.), including a review of best available evidence. There will be a focus on HO from the SCI Physical Therapy perspective (e.g. ROM, seating, WC modifications, maintaining function, etc). We will also review the use of screening measures (examination, labs, imaging) based on SCI scientific literature. Additionally, some have adopted strategies to routinely provide patients with prophylaxis against HO using NSAIDs for traumatic SCI patients who do not have a clear contraindication for NSAIDs. Initial data on the safety and efficacy of this strategy will be presented, including a summary of current literature on NSAID risk following spinal fracture and surgery.
0:00-00:10 Introduction of HO in SCI with Case Example; Crew and Hastings
0:10-00:30 Functional Implications and Practical Management of HO; Hastings
0:30-00:50 HO Prevention, Screening, and Treatment; Crew
0:50-01:00 Summary and Q[SPCHAR(A)] Crew and Hastings
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