The Journal of Bone and Joint Surgery, Vol 63, Issue 2 183-193, Copyright © 1981 by Journal of Bone and Joint Surgery, Inc
Spinal deformity in children treated for neuroblastoma
JK Mayfield, EJ Riseborough, N Jaffe and ME Nehme
Of seventy-four children who were treated at a mean age of seventeen months
for neuroblastoma and survived more than five years, fifty-six (76 per
cent) had spinal deformity due either to the disease or to the treatment
after a mean follow-up of 12.9 years. Of these fifty-six, 50 per cent had
post-radiation scoliosis (mean, 18 degrees; range, 5 to 79 degrees), and 16
per cent had post-radiation kyphosis, most frequently at the thoracolumbar
junction (mean, 39 degrees; range, 13 to 61 degrees), at the time of
follow-up. Two kyphotic thoracolumbar curve patterns were identified: (1)
an angular kyphosis with a short radius of curvature and its apex at the
twelfth thoracic and first lumbar vertebrae, and (2) a thoracic kyphosis
with a long radius of curvature that extended into the lumbar spine. The
post-radiation deformity--both the scoliosis and the kyphosis--progressed
with growth, the scoliosis at a rate of 1 degree per year and the kyphosis
at a rate of 3 degrees per year. Epidural spread of the neuroblastoma was
associated with most of the cases of severe scoliosis and kyphosis. The
deformity was due either to the laminectomy or to the paraplegia acting in
conjunction with the radiation. Eighteen per cent of 419 children with this
malignant disease survived more than five years, and of the survivors, 20
per cent had spinal deformity severe enough to warrant treatment. The
factors associated with the development of spinal deformity in patient
treated for neuroblastoma were: (1) orthovoltage radiation exceeding 3000
rads, (2) asymmetrical radiation of the spine, (3) thoracolumbar kyphosis,
and (4) epidural spread of the tumor.
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