Radiation myelopathy

Introduction
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By Edward J Dropcho MD

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. Dr. Edward Dropcho of Indiana University summarizes the clinical features, pathophysiology, and management issues for patients with radiation myelopathy.

Key points

  • 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.

In This Article

Introduction
Historical note and nomenclature
Clinical manifestations
Clinical vignette
Etiology
Pathogenesis and pathophysiology
Epidemiology
Prevention
Differential diagnosis
Diagnostic workup
Prognosis and complications
Management
References cited
Contributors