Post-carbon-ion radiotherapy vertebral pathological fractures in upper cervical primary malignant spinal tumors treated by occipito-cervical fusion

  • Satoshi Baba
  • Yoshihiro MatsumotoEmail author
  • Kenichi Kawaguchi
  • Keiichiro Iida
  • Hirokazu Saiwai
  • Seiji Okada
  • Akira Matsunobu
  • Yoshiyuki Shioyama
  • Yasuharu Nakashima
Orthopaedic Surgery



To describe the characteristic features of post-carbon-ion radiotherapy (CIRT) vertebral pathological fractures (VPFs) in upper cervical primary malignant spinal tumors (PMSTs) treated by occipito-cervical (OC) fusion.


OC fusion was performed for three consecutive patients with post-CIRT VPFs. The clinical results and imaging findings, including bone single-photon emission computed tomography (SPECT)/CT were prospectively collected.


No surgery-related wound complication and surgical site infection were noted. One patient experienced re-fracture and displacement of dens with the loosening of occipital screws and was treated by posterior revision surgery. At the final follow-up, all patients were alive without evidence of disease, and the solid OC fusion was confirmed. Bone SPECT/CT clearly revealed the effect of CIRT on bone turnover in the irradiated field.


The OC fusion with autologous bone grafts was a reliable option for the treatment of post-CIRT VPCs in the patients with upper cervical PMSTs. In addition, evaluation of the bone turnover at the irradiated field by bone SPECT/CT would help surgeons select an effective plan of care, such as fusion level and postoperative care.


Carbon-ion radiotherapy Occipito-cervical fusion Vertebral pathological fracture Upper cervical primary malignant spinal tumor 



This work was supported by a Grant-in-Aid for Scientific Research from the Japan Society for the Promotion of Science (#18K09067).

Compliance with ethical standards

Conflict of interest

The authors declare that they have no conflict of interest.

Ethical approval

The study was approved by the institutional review board at the Kyushu University Hospital (26-112).

Informed consent

Informed consent was obtained from all individual participants included in the study.


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Copyright information

© Springer-Verlag GmbH Germany, part of Springer Nature 2019

Authors and Affiliations

  • Satoshi Baba
    • 1
  • Yoshihiro Matsumoto
    • 1
    Email author
  • Kenichi Kawaguchi
    • 1
  • Keiichiro Iida
    • 1
  • Hirokazu Saiwai
    • 1
  • Seiji Okada
    • 1
  • Akira Matsunobu
    • 2
  • Yoshiyuki Shioyama
    • 2
  • Yasuharu Nakashima
    • 1
  1. 1.Department of Orthopaedic Surgery, Graduate School of Medical SciencesKyushu UniversityFukuokaJapan
  2. 2.Ion Beam Therapy CenterSAGA HIMAT FoundationTosuJapan

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