Neurogenic Heterotopic Ossification of the Hip After Prolonged Postoperative Coma Following Astrocytoma Surgery in an Adolescent: A Case Report

Abstract

Background: Neurogenic heterotopic ossification (NHO) is an uncommon but potentially disabling complication of severe neurological injury, particularly in pediatric patients. Case Presentation: We report the case of a 13-year-old adolescent who developed NHO of the hip following surgical treatment of an astrocytoma complicated by prolonged postoperative coma and immobilization. The patient progressively presented with hip pain and severe limitation of joint mobility, leading to significant functional impairment. Initial conservative management including analgesic therapy and structured physiotherapy failed to provide clinical improvement. Radiographs and computed tomography (CT) with three-dimensional reconstruction confirmed the presence of mature heterotopic ossification. Surgical excision was performed, resulting in complete pain relief and significant improvement in hip mobility, with flexion increasing from complete ankyloses preoperatively to approximately 110° and abduction to 40°. Discussion: A population. Imaging studies, especially computed tomography, are essential to confirm the maturity of heterotopic bone and guide the timing of surgical excision in patients presenting with severe functional limitation. Conclusion: At 1-year follow-up, the patient remained asymptomatic with no radiological evidence of recurrence. This case highlights the importance of early recognition of NHO in pediatric patients with prolonged immobilization and neurological injury, and supports surgical excision as an effective treatment once ossification maturity is confirmed.