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Neurogenic heterotopic ossification: from molecular mechanisms to clinical treatment
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DOI：10.1016/j.jot.2026.101176.png)
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Abstract
En 中文
Neurogenic heterotopic ossification (NHO), a disabling complication of severe central nervous system injuries, involves ectopic periarticular bone formation that causes profound functional impairments and reduced quality of life. This review highlights recent advances in NHO, especially focusing on the neuro-immune-osteogenic axis. Rather than a merely local disorder, NHO is a systemic response driven by neural, inflammatory, and interorgan signals, notably involving BMP/Smad, macrophage activation, and neuropeptide pathways. While combined-injury animal models advance mechanistic insights, they incompletely replicate human disease heterogeneity. Clinically, early diagnosis is hindered by nonspecific symptoms and insensitive radiography. Current treatments are mainly preventive or symptomatic, lacking efficacy for mature lesions. We highlight that addressing controversies in prophylaxis, surgical timing, and biomarker utility is essential. Future progress relies on validated early biomarkers, standardized imaging, mechanism-based therapeutics, and multidisciplinary precision management.
Keywords:
Clinical treatment
Ectopic bone formation
Molecular mechanisms
Nervous system injury
Neurogenic heterotopic ossification
Neuroimmune signalling
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