Journal of Korean Neurosurgical Society

The Korean Neurosurgical Society (대한신경외과학회)
권호 표지
DOI QR코드

DOI QR Code

The Effect of Perioperative Radiation Therapy on Spinal Bone Fusion Following Spine Tumor Surgery

  • Kim, Tae-Kyum (Department of Neurosurgery, Korea Cancer Center Hospital, Korea Institute of Radiological and Medical Sciences) ;
  • Cho, Wonik (Department of Neurosurgery, Korea Cancer Center Hospital, Korea Institute of Radiological and Medical Sciences) ;
  • Youn, Sang Min (Department of Neurosurgery, Korea Cancer Center Hospital, Korea Institute of Radiological and Medical Sciences) ;
  • Chang, Ung-Kyu (Department of Neurosurgery, Korea Cancer Center Hospital, Korea Institute of Radiological and Medical Sciences)
  • Received : 2016.05.17
  • Accepted : 2016.08.31
  • Published : 2016.11.01
Download PDF
⟨ Previous Next ⟩

Abstract

Introduction : Perioperative irradiation is often combined with spine tumor surgery. Radiation is known to be detrimental to healing process of bone fusion. We tried to investigate bone fusion rate in spine tumor surgery cases with perioperative radiation therapy (RT) and to analyze significant factors affecting successful bone fusion. Methods : Study cohort was 33 patients who underwent spinal tumor resection and bone graft surgery combined with perioperative RT. Their medical records and radiological data were analyzed retrospectively. The analyzed factors were surgical approach, location of bone graft (anterior vs. posterior), kind of graft (autologous graft vs. allograft), timing of RT (preoperative vs. postoperative), interval of RT from operation in cases of postoperative RT (within 1 month vs. after 1 month) radiation dose (above 38 Gy vs. below 38 Gy) and type of radiation therapy (conventional RT vs. stereotactic radiosurgery). The bone fusion was determined on computed tomography images. Result : Bone fusion was identified in 19 cases (57%). The only significant factors to affect bony fusion was the kind of graft (75% in autograft vs. 41 in allograft, p=0.049). Other factors proved to be insignificant relating to postoperative bone fusion. Regarding time interval of RT and operation in cases of postoperative RT, the time interval was not significant (p=0.101). Conclusion : Spinal fusion surgery which was combined with perioperative RT showed relatively low bone fusion rate (57%). For successful bone fusion, the selection of bone graft was the most important.

Keywords

References

  1. Bartels RH, Feuth T, van der Maazen R, Verbeek AL, Kappelle AC, Andre Grotenhuis J, et al. : Development of a model with which to predict the life expectancy of patients with spinal epidural metastasis. Cancer 110 : 2042-2049, 2007 https://doi.org/10.1002/cncr.23002
  2. Boden SD : The biology of posterolateral lumbar spinal fusion. Orthop Clin North Am 29 : 603-619, 1998 https://doi.org/10.1016/S0030-5898(05)70034-1
  3. Bouchard JA, Koka A, Bensusan JS, Stevenson S, Emery SE : Effects of irradiation on posterior spinal fusions. A rabbit model. Spine (Phila Pa 1976) 19 : 1836-1841, 1994 https://doi.org/10.1097/00007632-199408150-00008
  4. Chang EL, Shiu AS, Mendel E, Mathews LA, Mahajan A, Allen PK, et al. : Phase I/II study of stereotactic body radiotherapy for spinal metastasis and its pattern of failure. J Neurosurg Spine 7 : 151-160, 2007 https://doi.org/10.3171/SPI-07/08/151
  5. Ciftdemir M, Kaya M, Selcuk E, Yalniz E : Tumors of the spine. World J Orthop 7 : 109-116, 2016 https://doi.org/10.5312/wjo.v7.i2.109
  6. Emery SE, Brazinski MS, Koka A, Bensusan JS, Stevenson S : The biological and biomechanical effects of irradiation on anterior spinal bone grafts in a canine model. J Bone Joint Surg Am 76 : 540-548, 1994 https://doi.org/10.2106/00004623-199404000-00008
  7. Emery SE, Hughes SS, Junglas WA, Herrington SJ, Pathria MN : The fate of anterior vertebral bone grafts in patients irradiated for neoplasm. Clin Orthop Relat Res (300) : 207-212, 1994
  8. George R, Jeba J, Ramkumar G, Chacko AG, Tharyan P : Interventions for the treatment of metastatic extradural spinal cord compression in adults. Cochrane Database Syst Rev 4 : CD006716, 2015
  9. Goldberg VM, Stevenson S : Natural history of autografts and allografts. Clin Orthop Relat Res (225) : 7-16, 1987
  10. Harel R, Chao S, Krishnaney A, Emch T, Benzel EC, Angelov L : Spine instrumentation failure after spine tumor resection and radiation : comparing conventional radiotherapy with stereotactic radiosurgery outcomes. World Neurosurg 74 : 517-522, 2010 https://doi.org/10.1016/j.wneu.2010.06.037
  11. Heidecke V, Rainov NG, Burkert W : Results and outcome of neurosurgical treatment for extradural metastases in the cervical spine. Acta Neurochir (Wien) 145 : 873-880; discussion 880-881, 2003 https://doi.org/10.1007/s00701-003-0107-1
  12. Ibrahim A, Crockard A, Antonietti P, Boriani S, Bunger C, Gasbarrini A, et al. : Does spinal surgery improve the quality of life for those with extradural (spinal) osseous metastases? An international multicenter prospective observational study of 223 patients. Invited submission from the Joint Section Meeting on Disorders of the Spine and Peripheral Nerves, March 2007. J Neurosurg Spine 8 : 271-278, 2008 https://doi.org/10.3171/SPI/2008/8/3/271
  13. Lee MH, Lee SH, Kim ES, Eoh W, Chung SS, Lee CS : Survival-related factors of spinal metastasis with hepatocellular carcinoma in current surgical treatment modalities : a single institute experience. J Korean Neurosurg Soc 58 : 448-453, 2015 https://doi.org/10.3340/jkns.2015.58.5.448
  14. Lewandrowski KU, Hecht AC, DeLaney TF, Chapman PA, Hornicek FJ, Pedlow FX : Anterior spinal arthrodesis with structural cortical allografts and instrumentation for spine tumor surgery. Spine (Phila Pa 1976) 29 : 1150-1158; discussion 1159, 2004 https://doi.org/10.1097/00007632-200405150-00019
  15. Mantravadi RV, Skolnik EM, Applebaum EL : Complications of postoperative and preoperative radiation therapy in head and neck cancers. A comparative study. Arch Otolaryngol 107 : 690-693, 1981 https://doi.org/10.1001/archotol.1981.00790470038009
  16. Patchell RA, Tibbs PA, Regine WF, Payne R, Saris S, Kryscio RJ, et al. : Direct decompressive surgical resection in the treatment of spinal cord compression caused by metastatic cancer : a randomised trial. Lancet 366 : 643-648, 2005 https://doi.org/10.1016/S0140-6736(05)66954-1
  17. Peyre HM, Coffigny H, Reillaudou M, Beaumatin J, Morin M, Luccioni C : Transformation by radiation of rat foetal glial cells. Int J Radiat Biol 76 : 87-94, 2000 https://doi.org/10.1080/095530000139041
  18. Phulpin B, Dolivet G, Marie PY, Poussier S, Gallet P, Leroux A, et al. : Re-assessment of chronic radio-induced tissue damage in a rat hindlimb model. Exp Ther Med 1 : 553-560, 2010 https://doi.org/10.3892/etm_00000087
  19. Poffyn B, Sys G, Mulliez A, Van Maele G, Van Hoorebeke L, Forsyth R, et al. : Extracorporeally irradiated autografts for the treatment of bone tumours : tips and tricks. Int Orthop 35 : 889-895, 2011 https://doi.org/10.1007/s00264-010-1098-1
  20. Sanpakit S, Mansfield TL, Liebsch J : Role of onlay grafting with minimal internal fixation for occipitocervical fusion in oncologic patients. J Spinal Disord 13 : 382-390, 2000 https://doi.org/10.1097/00002517-200010000-00003
  21. She C, Shi GL, Xu W, Zhou XZ, Li J, Tian Y, et al. : Effect of low-dose Xray irradiation and Ti particles on the osseointegration of prosthetic. J Orthop Res 2016 Jan 30 [Epub]. http : //dx.doi.org/10.1002/jor.23179.
  22. Sherman RM, Waddell JP : Laminectomy for metastatic epidural spinal cord tumors. Posterior stabilization, radiotherapy, and preoperative assessment. Clin Orthop Relat Res (207) : 55-63, 1986
  23. Song XS, Zhou XZ, Zhang G, Dong QR, Qin L : Low-dose X-ray irradiation promotes fracture healing through up-regulation of vascular endothelial growth factor. Med Hypotheses 75 : 522-524, 2010 https://doi.org/10.1016/j.mehy.2010.07.012
  24. Takahashi S, Sugimoto M, Kotoura Y, Sasai K, Oka M, Yamamuro T : Long-term changes in the haversian systems following high-dose irradiation. An ultrastructural and quantitative histomorphological study. J Bone Joint Surg Am 76 : 722-738, 1994 https://doi.org/10.2106/00004623-199405000-00014
  25. Townsend PW, Rosenthal HG, Smalley SR, Cozad SC, Hassanein RE : Impact of postoperative radiation therapy and other perioperative factors on outcome after orthopedic stabilization of impending or pathologic fractures due to metastatic disease. J Clin Oncol 12 : 2345-2350, 1994 https://doi.org/10.1200/JCO.1994.12.11.2345
  26. Wong DA, Fornasier VL, MacNab I : Spinal metastases : the obvious, the occult, and the impostors. Spine (Phila Pa 1976) 15 : 1-4, 1990 https://doi.org/10.1097/00007632-199001000-00001
  27. Yu JI, Park HC, Ahn YC, Chung Y, Koom WS, Song SY : Variation in practice patterns of korean radiation oncologists for spine metastasis between 2009 and 2014. Cancer Res Treat 48 : 1102-1109, 2016 https://doi.org/10.4143/crt.2015.207

Cited by

  1. Basic concepts in metal work failure after metastatic spine tumour surgery vol.27, pp.4, 2016, https://doi.org/10.1007/s00586-017-5405-z
  2. Multidisciplinary surgical planning for en bloc resection of malignant primary cervical spine tumors involving 3D-printed models and neoadjuvant therapies: report of 2 cases vol.30, pp.4, 2016, https://doi.org/10.3171/2018.9.spine18607
  3. Multidisciplinary surgical planning for en bloc resection of malignant primary cervical spine tumors involving 3D-printed models and neoadjuvant therapies: report of 2 cases vol.30, pp.4, 2016, https://doi.org/10.3171/2018.9.spine18607
  4. Importance of Spinal Alignment in Primary and Metastatic Spine Tumors vol.132, pp.None, 2016, https://doi.org/10.1016/j.wneu.2019.08.161
  5. An Overview of Decision Making in the Management of Metastatic Spinal Tumors vol.55, pp.4, 2021, https://doi.org/10.1007/s43465-021-00368-8