Surgical Correction of Postradiation Spinal Deformity

Background: Radiation to the juxtaspinal area in children with malignant tumors inducesthe appearance of a postradiation spinal deformity (PRSD) with drastic progressionduring the growth spurt, so surgical correction is mandatory.Methods of surgical treatment depend on the age of the patient, and the typeand size of the spinal deformity.Methods: A long-term retrospective survey of 6 patients receiving surgical managementof kyphoscoliosis was conducted. The original tumors were 3 Wilms'tumors, 2 neuroblastomas, and 1 lymphoma. The mean length of time fortumor excision and subsequent radiation was 2.2 years. The total radiationdose averaged 3566 rad. The mean age at initial presentation was 6.1 yearsand that at spinal correction was 11.8 years. Single posterior surgery wasperformed in 3 cases, while the other 3 required anteroposterior correctiondue to severe deformity and scar contracture.Results: The curves of PRSD were concave toward the side irradiated, and thekyphotic component was more severely involved than was the scoliotic component.Four patients had favorable correction without curve progression.However, in the other 2 younger patients, due to thinness of their back, rigidangulation of the spine, poor bony stock, and medical comorbidity, spinalinstrumentation was rather difficult. Postoperative pseudarthrosis and subsequentrod protrusion occurred with progressive kyphosis.Conclusions: PRSDs consist of uncommon developmental vertebral anomalies, of whichcurved patterns occur in any combination, but most severely involve thepresence of collapsing kyphosis and soft tissue contracture. Surgical correctionmay be less effective, especially if the children are skinny and have lowbone stocks.