Study Design: Clinical case series.
Objective: To assess objective outcomes of surgical correction of post-external beam radiation therapy (ERBT) kyphosis in a series of five adults.
Summary Of Background Data: EBRT is a well-established treatment for many cancers in children and adults. One complication associated with EBRT is postirradiation spine deformity. Scoliosis is the most common deformity, but kyphosis also occurs frequently. Differences in deformity patterns are likely related to the location and intensity of radiation. To our knowledge, no studies have addressed treatment of these deformities in adults, and the most recent case series (of children) was published in 2005.
Methods: We present a series of five adults who underwent surgery for postirradiation kyphosis, with a mean follow-up of 3.8 years (range, 2.5-6.2 years).
Results: Surgery improved the kyphotic deformity in all patients. Overall mean kyphotic deformity correction was 56° and was larger for cervical/cervicothoracic deformities (mean, 76°) than for lumbar deformities (mean, 42°) at midterm follow-up. Patients reported significant improvements in pain and self-image. Consistent with prior case series of children, we observed a high rate of complications (mean, 1.4 complications per patient) in adults. Three patients each underwent an unplanned surgical procedure because of a complication.
Conclusion: The surgical treatment of postirradiation kyphotic spinal deformity is challenging, with common postoperative complications such as infection, instrumentation failure, and pseudarthrosis. However, with modern surgical techniques and spinal instrumentation, excellent deformity correction can be achieved and maintained. We recommend performing a two-stage procedure for cervicothoracic deformity, with anterior release followed by posterior fusion and instrumentation. In thoracolumbar deformities, correction can be achieved through single-stage posterior fusion. Rigid spinopelvic fixation with sacral-alar-iliac screws and second-stage anterior lumbar interbody fusion at L5-S1 is recommended to reduce nonunion risk. Cement augmentation of proximal and distal anchors can help prevent junctional failure.
Level Of Evidence: Level IV.
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Article Synopsis
- The study evaluates the use of vascularized rib grafts (VRG) for treating kyphosis in children after laminectomy and radiation therapy, noting high failure rates in spinal fusions due to compromised bone quality.
- Data from five patients who underwent this treatment showed successful outcomes with complete fusion and no kyphosis progression at follow-up periods of 21 to 63 months.
- Despite one patient experiencing complications, the findings suggest that using VRG can enhance spinal stability and is a viable option for managing post-surgery kyphosis in pediatric patients.
Difficulties in Treating Postirradiation Kyphosis in Adults: A Series of Five Cases.
Spine Deform
November 2019
Department of Orthopaedic Surgery, The Johns Hopkins University, 601 North Caroline Street, Baltimore, 21287, MD, USA. Electronic address:
Study Design: Clinical case series.
Objective: To assess objective outcomes of surgical correction of post-external beam radiation therapy (ERBT) kyphosis in a series of five adults.
Summary Of Background Data: EBRT is a well-established treatment for many cancers in children and adults.
Segmental pedicle screw fixation for a scoliosis patient with post-laminectomy and post-irradiation thoracic kyphoscoliosis of spinal astrocytoma.
Acta Med Okayama
May 2013
Department of Orthopaedic Surgery, Okayama University Graduate School of Medicine, Dentistry and Pharmaceutical Sciences, Japan.
Spinal deformity is an important clinical manifestation after surgery for spinal cord tumors. One-third of patients who receive laminectomies and irradiation of the spinal column develop scoliosis, kyphosis, or kyphoscoliosis. Recent reports indicate good results after scoliosis surgery using segmental pedicle screws and a navigation system, but these reported studies have not included surgery for post-laminectomy kyphosis.
View Article and Find Full Text PDFCervical vertebral osteoradionecrosis: surgical management, complications and flap coverage--a case report and brief review of the literature.
Eur Spine J
July 2009
Spinal Unit, Department of Orthopaedic Surgery, University Hospital of Nîmes, Place du Professeur Robert Debré, Nîmes, France.
A case description and a review of the literature. To report a case of deformity secondary to cervical vertebral osteoradionecrosis (ORN) associated with severe wound complications and review the pertinent medical literature. The incidence of deformity after ORN is rare and its association with extensive damage of soft tissues makes surgical treatment difficult.
View Article and Find Full Text PDFPostlaminectomy and postirradiation kyphosis in children and adolescents.
Clin Orthop Relat Res
September 1998
Department of Orthopaedic Surgery, Children's Medical Center, University of California, San Francisco, USA.
This is a retrospective review of 12 patients treated for severe postlaminectomy and postirradiation kyphosis by one surgeon from 1977 to 1994. The average age of the patients was 15 years with a range from 2 to 35 years. The duration of followup ranged from 24 months to 156 months with an average of 65 months.
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