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Study design <p>A systematic review and meta-analysis.</p> Objective <p>To 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.</p> Methods <p>Electronic 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.</p> Results <p>A 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 (<i>P</i> &lt; 0.05). Initial analysis indicated a positive correlation for UTI (<i>P</i> = 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, <i>P</i> &lt; 0.0001), and evidence for UTI was rated as very low-quality.</p> Conclusion <p>Male 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.</p> Graphical abstract <p></p>

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Risk factors and clinical correlations of heterotopic ossification following spinal cord injury: a systematic review and meta-analysis

  • 期刊论文

  • 出版模式：

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  • 发表日期：

    2026年6月1日

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  • Yulei Xie,
  • Liang Xie,
  • Anli Hu,
  • Chunyu Zhang,
  • Jingjing Liu,
  • Jingyi Lin,
  • Qingsong Ren,
  • Yinxu Wang,
  • Shan Wang

摘要

Study design

A systematic review and meta-analysis.

Objective

To 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.

Methods

Electronic 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.

Results

A 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.

Conclusion

Male 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.

Graphical abstract