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

Abstract

IntroductionPerioperative 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.MethodsStudy 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.ResultBone 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).ConclusionSpinal 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.

Factors Related to Instrumentation Failure in Titanium Mesh Reconstruction for Thoracic and Lumbar Tumors: Retrospective Analysis of 178 Patients

“…Generally, the history of radiotherapy before and after operation is the most common reported factor related to IF, probably due to weakening of the surrounding normal bone, repair of the surrounding soft tissue, and the decreased bone healing ability caused by radiotherapy. 24 To reduce the necessity for postoperative radiotherapy, it is particularly important to minimize intraoperative tumor contamination and get a negative resection margin. 9 Of the 28 patients who received radiotherapy before and after the operation in our series, 8 patients had implant failure, with a failure rate of 28.6% ( Table 1 ).…”

Instrumented Spinal Stabilization without Fusion for Spinal Metastatic Disease

“…58, 59 Patients with spinal metastatic disease typically receive postoperative radiation and chemotherapy that may impair new bone formation. 36, 37, 60–62 Corticosteroid administration can decrease bone mineral density and compromise osseous healing capacity. 63–65 The nutritional compromise observed in oncology patients may further preclude fusion occurrence.…”

Vascularized Rib Bone Grafting: Indications, Techniques, and Clinical Outcomes

“…Perioperative radiation has a fusion rate of only 57% and 75% when using without and with the use of autograft. 15 VBGs are more resistant to infection and are indicated if the patient has a history of osteomyelitis. Multiple-level corpectomy, tumor resection, and severe kyphosis are other indications for reduced fusion rates and indications for VBG.…”