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Journal of Neurology, Neurosurgery, and Psychiatry logoLink to Journal of Neurology, Neurosurgery, and Psychiatry
. 1972 Dec;35(6):888–898. doi: 10.1136/jnnp.35.6.888

Pathology of radiation myelopathy

R J Burns 1,2, A N Jones 1,2, J S Robertson 1,2
PMCID: PMC494198  PMID: 4647860

Abstract

After nothing the rarity of papers describing the pathology of delayed radiation necrosis of the spinal cord, the clinical and pathological findings from four cases are presented. The main pathological features are asymmetric demyelination of the lateral columns and to a lesser degree the posterior and anterior columns of white matter, with coagulative necrosis at the level of irradiation which affected the grey matter to a lesser degree. There is ascending and descending secondary tract degeneration, and poor glial response in the lesions themselves. Vascular changes, mainly hyalilne thickening of arteriolar walls, are present, but not in degree sufficient to explain the primary lesion. The discussion of the pathogenesis of the myelopathy weighs the merits of a primary vascular lesion against those of a primary effect of the radiation on neural tissue. The latter is favoured.

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Selected References

These references are in PubMed. This may not be the complete list of references from this article.

  1. Atkins H. L., Tretter P. Time-dose considerations in radiation myelopathy. Acta Radiol Ther Phys Biol. 1966;5:79–94. doi: 10.3109/02841856609139546. [DOI] [PubMed] [Google Scholar]
  2. Baldus S. Uber Spätschäden am Rückenmark nach Bestrahlung von Tumoren im Kopf- und Halsbereich. Z Laryngol Rhinol Otol. 1966 Feb;45(2):123–129. [PubMed] [Google Scholar]
  3. Coy P., Baker S., Dolman C. L. Progressive myelopathy due to radiation. Can Med Assoc J. 1969 Jun 28;100(24):1129–1133. [PMC free article] [PubMed] [Google Scholar]
  4. DYNES J. B., SMEDAL M. I. Radiation myelitis. Am J Roentgenol Radium Ther Nucl Med. 1960 Jan;83:78–87. [PubMed] [Google Scholar]
  5. Eyster E. F., Wilson C. B. Radiation myelopathy. J Neurosurg. 1970 Apr;32(4):414–420. doi: 10.3171/jns.1970.32.4.0414. [DOI] [PubMed] [Google Scholar]
  6. GILMORE S. A. The effects of x-irradiation on the spinal cords of neonatal rats. II. Histological observations. J Neuropathol Exp Neurol. 1963 Apr;22:294–301. doi: 10.1097/00005072-196304000-00008. [DOI] [PubMed] [Google Scholar]
  7. INNES J. R., CARSTEN A. Demyelinating or malacic myelopathy. A delayed effect of localized x-irradiation in experimental rats. Arch Neurol. 1961 Feb;4:190–199. doi: 10.1001/archneur.1961.00450080072008. [DOI] [PubMed] [Google Scholar]
  8. ITABASHI H. H., BEBIN J., DEJONG R. N. Postirradiation cervical myelopathy; report of two cases. Neurology. 1957 Dec;7(12):844–852. doi: 10.1212/wnl.7.12.844. [DOI] [PubMed] [Google Scholar]
  9. Kristensson K., Molin B., Sourander P. Delayed radiation lesions of the human spinal cord. Report of five cases. Acta Neuropathol. 1967 Aug 2;9(1):34–44. doi: 10.1007/BF00688156. [DOI] [PubMed] [Google Scholar]
  10. Lehmann W., Zett W., Neumeister K. Bestrahlungsfolgen am Halsmark nach Röntgentherapie von Tumoren in der Zervikalregion. I. Klinische Untersuchungen. Radiobiol Radiother (Berl) 1968;9(4):435–443. [PubMed] [Google Scholar]
  11. Locksmith J. P., Powers W. E. Permanent radiation myelopathy. Am J Roentgenol Radium Ther Nucl Med. 1968 Apr;102(4):916–926. [PubMed] [Google Scholar]
  12. MALAMUD N., BOLDREY E. B., WELCH W. K., FADELL E. J. Necrosis of brain and spinal cord following x-ray therapy. J Neurosurg. 1954 Jul;11(4):353–362. doi: 10.3171/jns.1954.11.4.0353. [DOI] [PubMed] [Google Scholar]
  13. Maier J. G., Perry R. H., Saylor W., Sulak M. H. Radiation myelitis of the dorsolumbar spinal cord. Radiology. 1969 Jul;93(1):153–160. doi: 10.1148/23.1.153. [DOI] [PubMed] [Google Scholar]
  14. PALLIS C. A., LOUIS S., MORGAN R. L. Radiation myelopathy. Brain. 1961 Sep;84:460–479. doi: 10.1093/brain/84.3.460. [DOI] [PubMed] [Google Scholar]
  15. Phillips T. L., Buschke F. Radiation tolerance of the thoracic spinal cord. Am J Roentgenol Radium Ther Nucl Med. 1969 Mar;105(3):659–664. doi: 10.2214/ajr.105.3.659. [DOI] [PubMed] [Google Scholar]
  16. Reagan T. J., Thomas J. E., Colby M. Y., Jr Chronic progressive radiation myelopathy. Its clinical aspects and differential diagnosis. JAMA. 1968 Jan 8;203(2):106–110. [PubMed] [Google Scholar]
  17. Tan B. C., Khor T. H. Radiation myelitis in carcinoma of the nasopharynx. Clin Radiol. 1969 Jul;20(3):329–331. doi: 10.1016/s0009-9260(69)80151-0. [DOI] [PubMed] [Google Scholar]
  18. Van Den Brenk H. A., Richter W., Hurley R. H. Radiosensitivity of the human oxygenated cervical spinal cord based on analysis of 357 cases receiving 4 MeV x rays in hyperbaric oxygen. Br J Radiol. 1968 Mar;41(483):205–214. doi: 10.1259/0007-1285-41-483-205. [DOI] [PubMed] [Google Scholar]

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