Lack of info on HO research

[andromeda1111]

A question to the medical researchers should be: What chemical reactions take place in the body that constitutes Heterotopic Ossification that can be altered and reversed to eliminate it?

The overgrowth of bone tissue occurs in some individuals who receive Artificial Implants, supposedly no one in the medical community has an answer for this, but is there any research involved that can identify potential catalysts that could pertain to ossification and prevention? such as calcium absorption, resorbtion, catabolic states: (break down of body tissues)drugs-prednisone, anabolic states: (buildng up, repair and healing of body tissues)drugs-anabolic steroids(potent anti-inflammmatories) HO occurs during inflammation of the bone tissue matrix - resulting in bone overgrowth indicating need for potent anti-inflammatories pre and post-op. Bone-inhibiting agents.,(Disodium Etidronate)is used post-op to minimize HO yet you need some bone growth for complete osteo-integration of the endplates, so there is a fine line on the amount of bone growth needed, and for what duration.

Supplemetal considerations, Hydroxyapitite (spelling? sorry) is what is primarily in the ossified tissues in HO patients.

Under certain conditions when the body does not produce or get enough of a substance it reacts by producing more (or sometimes none depending on which system is involved and how it functions) and it has to be supplemented. Examples: Thyroid is given for an inactive thyroid. If not enough water is ingested the body store it.

There has to be someway to apply everything I have mentioned to be taken into consideration in the prevention of Heterotopic Ossification, simply because chemical reactions cause it, therefore reversing and altering these same chemical reactions can prevent it.

I know this has to do with bone resorbtion, and how much and at what rate of duration.

I know there is a lot here and I may be giving anybody who reads this a headache and wondering what I am getting at, but I am not understanding why this condition is not further researched, because I think it could be eradicated with some effort within the medical researchers.

Anro1111

[JeffreyD]

Great subject...
I have been researching this as well, and basically have come up with few real answers; mostly theories. My guess is that it's not researched much because it is statistically rare, which means the funds aren't going to be available for research. I hate to sound cynical, but there's probably "no money in it".

Jeff

[Carolina]

Hey Guys-

You may have already seen this (I think it was posted on the BPSG) but it may answer at least some of the questions you posed.

http://www.emedicine.com/radio/topic336.htm

Carolina

[Alastair]

Hi Laura,
I think it is because it is such a hugely complex subject, and also because everybody is different, with their absorption rates that it has not been possible to try and put a simple standard down for the majority of people.

I know where you're coming from and in a perfect world it would be lovely to have everything "Just so" but am afraid that the human body is such a complex article that sometimes we just have to make the best of what we've got.
Best,
Alastair

[Harrison]

Carolina, thx for posting that...I posted that a while back on the BPSG (when I was allowed)!

The HO topic is very complex and under-researched. There are a few members of this forum that have had significant complications post ADR because of HO, and my heart goes out to them.

One of the main causes of HO post ADR (from my understanding based on speaking with patients and doctors) is an undersized endplate, which sinks into the softer (cancellous) bone material. This is one reason why endplate selection - and placement - is so critical. If placement and plate size are incorrect, then subsidence can (that's can, not will) occur, stimulating the bone growth (healing) response.

There is a related thread on HO here.

PS: Read more about the criticality of device placement in the new Charite' Surgery Paper.

I think the problem is that spinal surgeons are incredibly focused on their successes and ignore their failures. In other words, very little research is actually directed at why some patients fail. Yes it may be complex, but no more so than why some patients dont respond to certain medications. There is research into those issues.

Labels like "failed back surgery syndrome" dont do anything other than apply a descriptive label with no explanation. It allows us to neatly categorize the patients, but thats all.

If there was research into the failures in addition to the successes, then perhaops the so-called 80% success rates could approach 90 or 95% or higher. Oh, and vague definitions of "success" have not helped either.

I have a lot of leg pain in both legs at 10 months post-ADR. Has anyone called me to investigate? Have I had to fill out new data forms, questionairres, anything? No. Because rather than investigate these things they are ignored..unless the patient directs the research.

Its like anything else. When our rockets dont reach orbit we keep trying to find out why until they do. We do dont accept "80% of our rockets and aircraft dont crash."

I know, I know. Ive heard the old mantra "back surgery is complex, the system is complex, there are 100000 pain generators, we will never know...."

Imagine if physicists and mathematicians had that attitude about physics and math hundreds of years ago. The "appeal to complexity" is not an excuse to avoid making a concerted effort to solve fundamental questions of why some patients, who appear to be perfect candidates, experience poor outcomes.

Im not trying to sound bitter at all, but as one who works in researchg in the life sciences, I am continually amazed by the lack of truly penetrating questions and casual approach to understanding unsuccessful surgeries. "Failed Back Surgery Syndrom" does not even meet the medical criterion for a valid diagnosis...its a catch-all label of no explanatory value.

P.S. Alastair this was not directed at you. I posted it before I even read your post, above.

[Alastair]

Hi Paul,
I would just like to agree with you about the "failed back surgery syndrome" . There are certain members on here who have not made anything like a proper recovery. Some I have helped along and discussed all symptoms and suggested ways ahead which they have actually done. Some have progressed into full recovery but some -- -- -- for some unknown reason -- -- -- simply have not made a recovery at all. In fact there are one or two who are actually worse off than prior to surgery.

However 10 months is early days to be expecting a full recovery. If you are past the two year mark then I would start to get very concerned.


I have researched this as much as is humanly possible with the information that we have. Do remember we are "lay men" looking for answers in a highly scientific world. Even the spine magazine acknowledges that there are some failures which nobody knows the reason why this has happened.

There is no guarantee also that if we did know why failures had happened with spine surgeries that it could be rectified. We are talking here about human tissue and not steel as in Rockets etc all different stuff.

It is a frightening path to walk down.

Meanwhile we must all face the odds. Choose a surgeon that we think can do a good job and hope for success. Paul I know how you must be feeling.
Best wishes,
Alastair

[andromeda1111]

After reading Harrison's statement of the correct endplate size selection being paramount in reference to HO occuring, and investigating the referral to the HO article, this basically suggests that HO occurs in damaged tissues, the tissue no longer functions, nerve damage is present, lack of blood supply=tissue dies=converts to ossified bone. The other reference is the production of Bone Morphogenetic Protein 4 plays a role in HO. So this all tells me a lot... (the endplate selection being the most important) and allows me to come up with some conclusions during my post-op recovery plan.

Thanks Guys
Laura

[TXTony]

Laura,
Thanks for (re)starting this thread. More people need to know about this as a possible "complication" to ADR surgery before going under the knife.

BTW: I had X-rays done in December and saw no change + or - to the HO as compared to those done in May 2004. Looks like maybe the HO has matured. Now, the search for a means to have it excised.

Thanks,
Tony

[Harrison]

Laura, I really don't know if that is how the process works -- I believe there's more to it than "conversion," I believe it is a triggered bone growth response. But I am just speculating!

Tony, in your case, wasn't the bone growth around your artificial disc so dramatic that it now limits your movement? Was there "new" bone growth?