Peripheral nervous system injury after high-dose single-fraction image-guided stereotactic radiosurgery for spine tumors Journal Article


Authors: Stubblefield, M. D.; Ibanez, K.; Riedel, E. R.; Barzilai, O.; Laufer, I.; Lis, E.; Yamada, Y.; Bilsky, M. H.
Article Title: Peripheral nervous system injury after high-dose single-fraction image-guided stereotactic radiosurgery for spine tumors
Abstract: OBJECTIVE The object of this study was to determine the percentage of high-dose (1800-2600 cGy) single-fraction stereotactic radiosurgery (SF-SRS) treatments to the spine that result in peripheral nervous system (PNS) injury. METHODS All patients treated with SF-SRS for primary or metastatic spine tumors between January 2004 and May 2013 and referred to the Rehabilitation Medicine Service for evaluation and treatment of neuromuscular, musculoskeletal, or functional impairments or pain were retrospectively identified. RESULTS Five hundred fifty-seven SF-SRS treatments in 447 patients resulted in 14 PNS injuries in 13 patients. All injures resulted from SF-SRS delivered to the cervical or lumbosacral spine at 2400 cGy. The overall percentage of SFSRS treatments resulting in PNS injury was 2.5%, increasing to 4.5% when the thoracic spine was excluded from analysis. The median time to symptom onset following SF-SRS was 10 months (range 4-32 months). The plexus (cervical, brachial, and/or lumbosacral) was affected clinically and/or electrophysiologically in 12 (86%) of 14 cases, the nerve root in 2 (14%) of 14, and both in 6 (43%) of 14 cases. All patients experienced pain and most (93%) developed weakness. Peripheral nervous system injuries were CTCAE Grade 1 in 14% of cases, 2 in 64%, and 3 in 21%. No dose relationship between SF-SRS dose and PNS injury was detected. CONCLUSIONS Single-fraction SRS to the spine can result in PNS injury with major implications for function and quality of life. © AANS, 2017.
Keywords: adolescent; adult; aged; aged, 80 and over; middle aged; retrospective studies; young adult; diagnostic imaging; retrospective study; postoperative complications; radiosurgery; spine; spinal neoplasms; complications; peripheral nerve; peripheral nervous system; neuralgia; adverse effects; injuries; very elderly; humans; human; male; female
Journal Title: Neurosurgical Focus
Volume: 42
Issue: 3
ISSN: 1092-0684
Publisher: American Association of Neurological Surgeons  
Date Published: 2017-03-01
Start Page: E12
Language: English
DOI: 10.3171/2016.11.focus16348
PUBMED: 28245730
PROVIDER: scopus
PMCID: PMC5546836
DOI/URL:
Notes: Article -- Export Date: 3 April 2017 -- Source: Scopus
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MSK Authors
  1. Eric Lis
    102 Lis
  2. Yoshiya Yamada
    357 Yamada
  3. Mark H Bilsky
    220 Bilsky
  4. Ilya Laufer
    97 Laufer