Mitchell Stuart L, Donaldson Callum J, El Dafrawy Mostafa H, Kebaish Khaled M
Department of Orthopaedic Surgery, The Johns Hopkins University, 601 North Caroline Street, Baltimore, 21287, MD, USA.
King's College London, Strand, London, WC2R 2LS, United Kingdom.
Spine Deform. 2019 Nov;7(6):937-944. doi: 10.1016/j.jspd.2019.01.008.
Clinical case series.
To assess objective outcomes of surgical correction of post-external beam radiation therapy (ERBT) kyphosis in a series of five adults.
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.
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).
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.
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 IV.
临床病例系列。
评估5例成人患者接受体外照射放疗（ERBT）后脊柱后凸畸形手术矫正的客观疗效。
体外照射放疗是治疗儿童和成人多种癌症的成熟方法。与体外照射放疗相关的一种并发症是放疗后脊柱畸形。脊柱侧凸是最常见的畸形，但脊柱后凸也经常发生。畸形模式的差异可能与放疗的部位和强度有关。据我们所知，尚无研究涉及成人这些畸形的治疗，最近的病例系列（针对儿童）发表于2005年。
我们报告了5例接受放疗后脊柱后凸畸形手术的成人患者，平均随访3.8年（范围2.5 - 6.2年）。
手术改善了所有患者脊柱后凸畸形。中期随访时，总体平均脊柱后凸畸形矫正角度为56°，颈椎/颈胸段畸形（平均76°）的矫正角度大于腰椎畸形（平均42°）。患者报告疼痛和自我形象有显著改善。与先前儿童病例系列一致，我们观察到成人并发症发生率较高（平均每位患者1.4例并发症）。3例患者因并发症各自接受了计划外手术。
放疗后脊柱后凸畸形的手术治疗具有挑战性，存在感染、内固定失败和假关节形成等常见术后并发症。然而，采用现代手术技术和脊柱内固定，可实现并维持良好的畸形矫正。我们建议对颈胸段畸形采用两阶段手术，先行前路松解，然后后路融合及内固定。对于胸腰段畸形，可通过单阶段后路融合实现矫正。建议采用骶骨-翼-髂骨螺钉进行坚强的脊柱骨盆固定，并在L5 - S1行二期前路腰椎椎间融合术以降低不愈合风险。近端和远端锚钉的骨水泥强化有助于预防交界区失败。
四级。
