J Korean Neurosurg Soc.  2016 Nov;59(6):597-603. 10.3340/jkns.2016.59.6.597.

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

• Kim TK
• Cho W
• Youn SM
• Chang UK

• KMID: 2417342
• DOI: http://doi.org/10.3340/jkns.2016.59.6.597

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.

Keyword

Spine tumor; Bone fusion; Bone graft; Radiation therapy

MeSH Terms

Allografts
Autografts
Cohort Studies
Humans
Medical Records
Retrospective Studies
Spinal Fusion
Spine*
Transplants

Figure

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  Fig. 1 A : Fusion state, grade 1 by Bridwell grading system. Bone remodeling and trabeculae are seen between cage and adjacent vertebral bodies. B : Fusion state, Post instrumentation and on lay graft with allobone; grade 2 indicates probable fusion (graft intact, not fully remodeled). C : Non-fusion state; grade 3 by Bridwell grading system (graft intact but lucency where it contacted the host bone surface). D : Non-fusion state; grade 4 by Bridwell grading system (graft resorbed).

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  Fig. 2 Fusion success rate according to each of the prognostic factors on surgical aspect. The kind of bone graft was only significant factor related successful bony fusion (p=0.049).

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  Fig. 3 Fusion success rate according to each of the prognostic factors on irradiation aspect. There was no significant factors relating to successful bony fusion on irradiation aspect.

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  Fig. 4 A case of perioperative stereotactic radiosurgery planning. There was relative sparing of the ventral and dorsal fusion surface.

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