Spinal cord compression secondary to kyphosis associated with radiation therapy for metastatic disease

Three patients were treated for pathologic fractures of the thoracolumbar spine causing progressive neurologic deficit. An anterior decompression with partial removal of the diseased vertebra was performed with improvement of neurologic function in each patient. Active tumor was not found, but necrotic bone with collapse and secondary kyphosis were the causes of anterior compression of the spinal cord. In two patients, the spine was stabilized with an anterior fibular strut graft that initially provided stability; later collapse progressed and deformity recurred. In the third patient, stabilization was secured with internal fixation that has prevented a recurrent deformity. Late collapse of a vertebral body after irradiation for tumor may be secondary to necrosis resulting from tumor infiltration and/or radiotherapy. Anterior decompression and stabilization with adjunctive internal fixation can be beneficial in selected cases.