Heterotopic Ossification in Neurorehabilitation

Neurogenic heterotopic ossification (NHO) involves deposition of bone in extraskeletal tissue in the setting of a neurological disorder, and its pathophysiology is incompletely understood. NHO can lead to significant disability and functional impairment. NHO initially manifests as pain and joint stiffness. Early diagnosis requires appropriate suspicion and imaging studies to detect the uncalcified collagen matrix that forms in the early stages of NHO. If diagnosis is made in the early phase of NHO, progression may be halted with bisphosphonates, indomethacin or radiation therapy. If NHO progresses to its final stages without intervention, it may restrict joints and render them dysfunctional. Surgical treatment of NHO may restore function, but complications may occur, and prophylaxis and aggressive rehabilitation are essential.