SynthesisJournal of orthopaedic surgery and research2026
Risk factors and clinical correlations of heterotopic ossification following spinal cord injury: a systematic review and meta-analysis.
Synthesis in Journal of orthopaedic surgery and research, 2026. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Not yet cited in PubMed.
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9 authors.
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Abstract
STUDY
designA systematic review and meta-analysis.
objectiveTo systematically evaluate the clinical correlates and relative risks of heterotopic ossification (HO) following spinal cord injury (SCI), and to provide an evidence-based framework for clinical HO prevention based on the Grading of Recommendations Assessment, Development and Evaluation (GRADE) system.
methodsElectronic literature searches were conducted across four databases: PubMed, Web of Science, Embase, and the Cochrane Library. Statistical analyses were performed using Review Manager 5.4 and R 4.5.2. Risk of bias and evidence quality were systematically assessed utilizing the Quality In Prognosis Studies (QUIPS) tool and the GRADE framework.
resultsA total of 11 studies (n = 2,647) were included in the meta-analysis. The results demonstrated that complete SCI, male sex, pressure ulcers, spasticity, and DVT were significantly associated with the occurrence of HO post-SCI (P < 0.05). Initial analysis indicated a positive correlation for UTI (P = 0.02); however, sensitivity analysis revealed insufficient robustness. Cervical versus thoracic injury level, smoking status, and pneumonia exhibited no significant associations with HO. GRADE Assessment: Evidence for male sex, spasticity, pressure ulcers, and DVT was rated as moderate-quality. Complete SCI was downgraded to low-quality evidence due to publication bias (trim-and-fill adjusted OR = 5.45, 95% CI 3.78-7.84, P < 0.0001), and evidence for UTI was rated as very low-quality.
conclusionMale sex, spasticity, pressure ulcers, and DVT are reliable predictors for the development of HO following SCI. Furthermore, patients with complete SCI should be monitored as a high-risk cohort. These findings suggest that the aforementioned factors can serve as critical indicators for early screening and intervention of HO. Future high-quality prospective studies are warranted to further validate these potential associations.
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