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Spinal deformity in children treated for neuroblastoma
Insights
Neuroblastoma survivors frequently develop spinal deformities like scoliosis and kyphosis due to treatment or disease progression. These conditions, including post-radiation scoliosis and kyphosis, often worsen over time.
Area of Science:
- Pediatric Oncology
- Orthopedic Surgery
- Radiation Oncology
Background:
- Neuroblastoma is a common childhood cancer.
- Spinal deformity is a known complication in neuroblastoma survivors.
- Long-term follow-up is crucial for assessing treatment sequelae.
Purpose of the Study:
- To investigate the incidence and progression of spinal deformities in children treated for neuroblastoma.
- To identify factors associated with the development of spinal deformity.
Main Methods:
- Retrospective analysis of 74 children treated for neuroblastoma who survived >5 years.
- Assessment of spinal deformity (scoliosis, kyphosis) via clinical and radiological evaluation.
- Correlation of deformity with treatment parameters (radiation dose, asymmetry) and disease factors (epidural spread).
Main Results:
- 76% of survivors developed spinal deformity (scoliosis, kyphosis) after a mean follow-up of 12.9 years.
- Post-radiation scoliosis (50%) and kyphosis (16%) were common, progressing annually.
- Severe deformities were linked to high-dose/asymmetrical radiation and epidural tumor spread.
Conclusions:
- Spinal deformity is a significant long-term complication in neuroblastoma survivors.
- Radiation therapy and tumor characteristics are key factors in deformity development.
- Regular monitoring and early intervention are essential for managing spinal deformities in this population.
Abstract:
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.