Radiation myelopathy is a relatively rare, but potentially devastating, complication of therapeutic irradiation. The growing use of stereotactic radiosurgery for metastatic or primary spinal tumors requires re-evaluation of the traditional dose-volume risk for radiation myelopathy as derived from standard fractionated radiation therapy. The author summarizes the clinical features, pathophysiology, and management issues for patients with radiation myelopathy.
• Radiation myelopathy is a rare complication of modern therapeutic irradiation.
• The generally accepted dose/fractionation parameters predicting the risk of radiation myelopathy may not necessarily apply to patients who receive a second course of radiation, concurrent radiation plus chemotherapy, or spinal stereotactic radiosurgery.
• Most patients with radiation myelopathy are permanently neurologically disabled; there is no proven effective therapy.
Historical note and terminology
Spinal cord injury following therapeutic irradiation was first recognized in the mid-1940s, shortly after the introduction of megavoltage radiotherapy (Boden 1948; Greenfield and Stark 1948). The term "radiation myelopathy" encompasses at least 3 distinct clinicopathologic entities: (1) a common, but mild and transient subacute myelopathy; (2) a less common, but catastrophic "delayed" progressive myelopathy; and (3) an unusual selective lower motor neuron syndrome. Therapeutic irradiation has also been implicated in the induction of spinal cord neoplasms or vascular malformations.
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