title: Lumbar corpectomy for correction of degenerative scoliosis from osteoradionecrosis reveals a delayed complication of lumbar myxopapillary ependymoma.
abstract: Osteoradionecrosis is a known complication following radiation therapy, presenting most commonly in the cervical spine as a delayed consequence of radiation that is often necessary in the management of head and neck cancers. In contrast, osteoradionecrosis has rarely been described in the lumbar spine. Here we describe, to our knowledge, the first reported case of lumbar spine osteoradionecrosis, after adjuvant radiation for a primary spinal cord tumor, leading to progressive degenerative scoliosis which required subsequent operative management. Established guidelines recommend that mature bone can tolerate a dose of up to 6000 cGy without injury. However, once bone has been exposed to radiation over this level progressive soft tissue changes may lead to devascularization, leaving the bone vulnerable to osteonecrosis, specifically when manipulated. Radiation necrosis can be progressive and lead to eventual mechanical instability requiring debridement and surgical fixation. In the setting of the lumbar spine, osseous necrosis can lead to biomechanical instability, deformity, pain, and neurologic deficit.
authors.affiliation: University of Arizona, Department of Surgery, Division of Neurosurgery, 1501 N. Campbell Avenue, Tucson, AZ 85724-5070, USA.
authors.forename: Sheri K
authors.initials: SK
authors.lastname: Palejwala
authors.affiliation: University of Arizona, Department of Orthopaedic Surgery, 1501 N. Campbell Avenue, Tucson, AZ 85724-5070, USA.
authors.forename: Kevin A
authors.initials: KA
authors.lastname: Lawson
authors.affiliation: University of Arizona, College of Medicine, 1501 N. Campbell Avenue, Tucson, AZ 85724-5070, USA. Electronic address: seanlkent@email.arizona.edu.
authors.forename: Sean L
authors.initials: SL
authors.lastname: Kent
authors.affiliation: University of Arizona, Department of Surgery, Division of Neurosurgery, 1501 N. Campbell Avenue, Tucson, AZ 85724-5070, USA.
authors.forename: Nikolay L
authors.initials: NL
authors.lastname: Martirosyan
authors.affiliation: University of Arizona, Department of Surgery, Division of Neurosurgery, 1501 N. Campbell Avenue, Tucson, AZ 85724-5070, USA.
authors.forename: Travis M
authors.initials: TM
authors.lastname: Dumont
mesh_terms: D000368:Aged; D004806:Ependymoma / Q000150:complications / Q000000981:diagnostic imaging / Q000601:surgery*; D006801:Humans; D008159:Lumbar Vertebrae / Q000000981:diagnostic imaging / Q000601:surgery*; D008297:Male; D010025:Osteoradionecrosis / Q000150:complications / Q000000981:diagnostic imaging / Q000601:surgery*; D011832:Radiation Injuries / Q000150:complications / Q000000981:diagnostic imaging / Q000601:surgery; D012600:Scoliosis / Q000000981:diagnostic imaging / Q000209:etiology / Q000601:surgery*; D013123:Spinal Fusion / Q000295:instrumentation / Q000379:methods*; D013125:Spinal Neoplasms / Q000150:complications / Q000000981:diagnostic imaging / Q000601:surgery*
keywords: Degenerative adult scoliosis; Lumbar corpectomy; Myxopapillary ependymoma; Osteoradionecrosis