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Arch Orthop Trauma Surg. 2019 Apr 3. doi: 10.1007/s00402-019-03183-x. [Epub ahead of print]

Post-carbon-ion radiotherapy vertebral pathological fractures in upper cervical primary malignant spinal tumors treated by occipito-cervical fusion.

Author information

1
Department of Orthopaedic Surgery, Graduate School of Medical Sciences, Kyushu University, Fukuoka, 812-8582, Japan.
2
Department of Orthopaedic Surgery, Graduate School of Medical Sciences, Kyushu University, Fukuoka, 812-8582, Japan. ymatsu@ortho.med.kyushu-u.ac.jp.
3
Ion Beam Therapy Center, SAGA HIMAT Foundation, Tosu, Japan.

Abstract

PURPOSE:

To describe the characteristic features of post-carbon-ion radiotherapy (CIRT) vertebral pathological fractures (VPFs) in upper cervical primary malignant spinal tumors (PMSTs) treated by occipito-cervical (OC) fusion.

METHODS:

OC fusion was performed for three consecutive patients with post-CIRT VPFs. The clinical results and imaging findings, including bone single-photon emission computed tomography (SPECT)/CT were prospectively collected.

RESULTS:

No surgery-related wound complication and surgical site infection were noted. One patient experienced re-fracture and displacement of dens with the loosening of occipital screws and was treated by posterior revision surgery. At the final follow-up, all patients were alive without evidence of disease, and the solid OC fusion was confirmed. Bone SPECT/CT clearly revealed the effect of CIRT on bone turnover in the irradiated field.

CONCLUSION:

The OC fusion with autologous bone grafts was a reliable option for the treatment of post-CIRT VPCs in the patients with upper cervical PMSTs. In addition, evaluation of the bone turnover at the irradiated field by bone SPECT/CT would help surgeons select an effective plan of care, such as fusion level and postoperative care.

KEYWORDS:

Carbon-ion radiotherapy; Occipito-cervical fusion; Upper cervical primary malignant spinal tumor; Vertebral pathological fracture

PMID:
30944982
DOI:
10.1007/s00402-019-03183-x

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