Osteobiologic recombinant human bone morphogenetic protein 2 (rhBMP-2) related
Total disc replacement (TDR) related
Anterior cervical discectomy and fusion (ACDF) adjacent segment related
IMAGING
General Features
CT Findings
MR Findings
Imaging Recommendations
DIFFERENTIAL DIAGNOSIS
PATHOLOGY
General Features
Staging, Grading, & Classification
CLINICAL ISSUES
Presentation
Treatment
DIAGNOSTIC CHECKLIST
Consider
Selected References
Feng JT et al: Efficacy and safety of bone substitutes in lumbar spinal fusion: a systematic review and network meta-analysis of randomized controlled trials. Eur Spine J. ePub, 2019
Manzur M et al: The rate of fusion for stand-alone anterior lumbar interbody fusion: a systematic review. Spine J. 19(7):1294-1301, 2019
Kong L et al: The prevalence of heterotopic ossification among patients after cervical artificial disc replacement: a systematic review and meta-analysis. Medicine (Baltimore). 96(24):e7163, 2017
Kang J et al: Factors that may affect outcome in cervical artificial disc replacement: a systematic review. Eur Spine J. 24(9):2023-32, 2015
Simmonds MC et al: Safety and effectiveness of recombinant human bone morphogenetic protein-2 for spinal fusion: a meta-analysis of individual-participant data. Ann Intern Med. 158(12):877-89, 2013
Singh K et al: Clinical sequelae after rhBMP-2 use in a minimally invasive transforaminal lumbar interbody fusion. Spine J. 13(9):1118-25, 2013
Du J et al: Early follow-up outcomes after treatment of degenerative disc disease with the discover cervical disc prosthesis. Spine J. 11(4):281-9, 2011
Mannion RJ et al: Promoting fusion in minimally invasive lumbar interbody stabilization with low-dose bone morphogenic protein-2--but what is the cost? Spine J. 11(6):527-33, 2011
Quan GM et al: Eight-year clinical and radiological follow-up of the Bryan cervical disc arthroplasty. Spine (Phila Pa 1976). 36(8):639-46, 2011
Chen NF et al: Symptomatic ectopic bone formation after off-label use of recombinant human bone morphogenetic protein-2 in transforaminal lumbar interbody fusion. J Neurosurg Spine. 12(1):40-6, 2010
Coric D et al: Prospective study of cervical arthroplasty in 98 patients involved in 1 of 3 separate investigational device exemption studies from a single investigational site with a minimum 2-year follow-up. Clinical article. J Neurosurg Spine. 13(6):715-21, 2010
Kim PD et al: Ectopic bone formation in the pelvis after combined anterior and posterior fusion of the spine with osteogenic protein-1 use: a case report. J Spinal Disord Tech. 23(3):215-20, 2010
Ryu KS et al: Radiological changes of the operated and adjacent segments following cervical arthroplasty after a minimum 24-month follow-up: comparison between the Bryan and Prodisc-C devices. J Neurosurg Spine. 13(3):299-307, 2010
Suchomel P et al: Clinical results and development of heterotopic ossification in total cervical disc replacement during a 4-year follow-up. Eur Spine J. 19(2):307-15, 2010
Yi S et al: Difference in occurrence of heterotopic ossification according to prosthesis type in the cervical artificial disc replacement. Spine (Phila Pa 1976). 35(16):1556-61, 2010
Beaurain J et al: Intermediate clinical and radiological results of cervical TDR (Mobi-C) with up to 2 years of follow-up. Eur Spine J. 18(6):841-50, 2009
Geibel PT et al: The use of recombinant human bone morphogenic protein in posterior interbody fusions of the lumbar spine: a clinical series. J Spinal Disord Tech. 22(5):315-20, 2009
Kerr EJ et al: Implant design may influence delayed heterotopic ossification after total disk arthroplasty in lumbar spine. Surg Neurol. 72(6):747-51; discussion 751, 2009
Wong DA et al: Neurologic impairment from ectopic bone in the lumbar canal: a potential complication of off-label PLIF/TLIF use of bone morphogenetic protein-2 (BMP-2). Spine J. 8(6):1011-8, 2008
Joseph V et al: Heterotopic bone formation with the use of rhBMP2 in posterior minimal access interbody fusion: a CT analysis. Spine (Phila Pa 1976). 32(25):2885-90, 2007
Mehren C et al: Heterotopic ossification in total cervical artificial disc replacement. Spine (Phila Pa 1976). 31(24):2802-6, 2006
Haid RW Jr et al: Posterior lumbar interbody fusion using recombinant human bone morphogenetic protein type 2 with cylindrical interbody cages. Spine J. 4(5):527-38; discussion 538-9, 2004
McAfee PC et al: Classification of heterotopic ossification (HO) in artificial disk replacement. J Spinal Disord Tech. 16(4):384-9, 2003
Related Anatomy
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Related Differential Diagnoses
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References
Tables
Tables
KEY FACTS
Terminology
Imaging
Top Differential Diagnoses
Pathology
Clinical Issues
Diagnostic Checklist
TERMINOLOGY
Synonyms
Heterotopic ossification (HO)
Ectopic bone formation
Ectopic ossification
Extradiscal ossification
Definitions
Bone development in abnormal location
Occurs in 3 main scenarios
Osteobiologic recombinant human bone morphogenetic protein 2 (rhBMP-2) related
Total disc replacement (TDR) related
Anterior cervical discectomy and fusion (ACDF) adjacent segment related
IMAGING
General Features
CT Findings
MR Findings
Imaging Recommendations
DIFFERENTIAL DIAGNOSIS
PATHOLOGY
General Features
Staging, Grading, & Classification
CLINICAL ISSUES
Presentation
Treatment
DIAGNOSTIC CHECKLIST
Consider
Selected References
Feng JT et al: Efficacy and safety of bone substitutes in lumbar spinal fusion: a systematic review and network meta-analysis of randomized controlled trials. Eur Spine J. ePub, 2019
Manzur M et al: The rate of fusion for stand-alone anterior lumbar interbody fusion: a systematic review. Spine J. 19(7):1294-1301, 2019
Kong L et al: The prevalence of heterotopic ossification among patients after cervical artificial disc replacement: a systematic review and meta-analysis. Medicine (Baltimore). 96(24):e7163, 2017
Kang J et al: Factors that may affect outcome in cervical artificial disc replacement: a systematic review. Eur Spine J. 24(9):2023-32, 2015
Simmonds MC et al: Safety and effectiveness of recombinant human bone morphogenetic protein-2 for spinal fusion: a meta-analysis of individual-participant data. Ann Intern Med. 158(12):877-89, 2013
Singh K et al: Clinical sequelae after rhBMP-2 use in a minimally invasive transforaminal lumbar interbody fusion. Spine J. 13(9):1118-25, 2013
Du J et al: Early follow-up outcomes after treatment of degenerative disc disease with the discover cervical disc prosthesis. Spine J. 11(4):281-9, 2011
Mannion RJ et al: Promoting fusion in minimally invasive lumbar interbody stabilization with low-dose bone morphogenic protein-2--but what is the cost? Spine J. 11(6):527-33, 2011
Quan GM et al: Eight-year clinical and radiological follow-up of the Bryan cervical disc arthroplasty. Spine (Phila Pa 1976). 36(8):639-46, 2011
Chen NF et al: Symptomatic ectopic bone formation after off-label use of recombinant human bone morphogenetic protein-2 in transforaminal lumbar interbody fusion. J Neurosurg Spine. 12(1):40-6, 2010
Coric D et al: Prospective study of cervical arthroplasty in 98 patients involved in 1 of 3 separate investigational device exemption studies from a single investigational site with a minimum 2-year follow-up. Clinical article. J Neurosurg Spine. 13(6):715-21, 2010
Kim PD et al: Ectopic bone formation in the pelvis after combined anterior and posterior fusion of the spine with osteogenic protein-1 use: a case report. J Spinal Disord Tech. 23(3):215-20, 2010
Ryu KS et al: Radiological changes of the operated and adjacent segments following cervical arthroplasty after a minimum 24-month follow-up: comparison between the Bryan and Prodisc-C devices. J Neurosurg Spine. 13(3):299-307, 2010
Suchomel P et al: Clinical results and development of heterotopic ossification in total cervical disc replacement during a 4-year follow-up. Eur Spine J. 19(2):307-15, 2010
Yi S et al: Difference in occurrence of heterotopic ossification according to prosthesis type in the cervical artificial disc replacement. Spine (Phila Pa 1976). 35(16):1556-61, 2010
Beaurain J et al: Intermediate clinical and radiological results of cervical TDR (Mobi-C) with up to 2 years of follow-up. Eur Spine J. 18(6):841-50, 2009
Geibel PT et al: The use of recombinant human bone morphogenic protein in posterior interbody fusions of the lumbar spine: a clinical series. J Spinal Disord Tech. 22(5):315-20, 2009
Kerr EJ et al: Implant design may influence delayed heterotopic ossification after total disk arthroplasty in lumbar spine. Surg Neurol. 72(6):747-51; discussion 751, 2009
Wong DA et al: Neurologic impairment from ectopic bone in the lumbar canal: a potential complication of off-label PLIF/TLIF use of bone morphogenetic protein-2 (BMP-2). Spine J. 8(6):1011-8, 2008
Joseph V et al: Heterotopic bone formation with the use of rhBMP2 in posterior minimal access interbody fusion: a CT analysis. Spine (Phila Pa 1976). 32(25):2885-90, 2007
Mehren C et al: Heterotopic ossification in total cervical artificial disc replacement. Spine (Phila Pa 1976). 31(24):2802-6, 2006
Haid RW Jr et al: Posterior lumbar interbody fusion using recombinant human bone morphogenetic protein type 2 with cylindrical interbody cages. Spine J. 4(5):527-38; discussion 538-9, 2004
McAfee PC et al: Classification of heterotopic ossification (HO) in artificial disk replacement. J Spinal Disord Tech. 16(4):384-9, 2003
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