Irradiation

For some spinal cord tumors, radiation therapy may be the primary form of treatment. In a growing child, doses to the
vertebral column exceeding 1000 rad may have an inhibitory effect on the physeal regions.
[513]
As a result,
asymmetric growth may develop, leading to a scoliotic or kyphotic deformity. Spinal deformity may also result from
soft tissue fibrosis and contractures.
Very young children who receive radiation (often for Wilms' tumor or neuroblastoma) are at greatest risk for
developing spinal deformities.
[343,451,459,556,613,614]
Long-term follow-up of these individuals is necessary because
deformities can worsen notably during the adolescent growth spurt. Every effort should be made to exclude the spine
or pelvis from the radiation field in young children.
Bracing has not proved effective in arresting the progression of irradiation-induced spinal deformity. However, it
continues to be used in patients with scoliosis exceeding 20 degrees in an effort to delay progression of the
deformity. When scoliosis exceeds 40 to 45 degrees, operative intervention should be undertaken. Healing may be
prolonged, and consideration should be given to repeat bone grafting 6 months postoperatively. The risk of
postoperative complications, including pseudarthrosis and infection, is increased.
For postirradiation kyphosis, anterior fusion is needed along with posterior fusion in an effort to avoid the likelihood of
pseudarthrosis.
[534]
For sharply angled kyphotic deformities, a vascularized rib strut graft is recommended.
Postoperative bracing for 6 to 12 months should be considered in these patients.
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