University of Oulu

Grahn, P., Remes, T., Kivisaari, R. et al. Early disc degeneration in radiotherapy-treated childhood brain tumor survivors. BMC Musculoskelet Disord 24, 441 (2023).

Early disc degeneration in radiotherapy-treated childhood brain tumor survivors

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Author: Grahn, Petra1; Remes, Tiina2,3; Kivisaari, Reetta4;
Organizations: 1Department of Pediatric Orthopedics and Traumatology, University of Helsinki and Helsinki University Hospital, Stenbäckinkatu 9, PL 281, 00029, Helsinki, Finland
2Department of Pediatrics and Adolescent Medicine, Oulu University Hospital, and Research Unit of Clinical Medicine, University of Oulu, Helsinki, Finland
3Department of Child Neurology, New Children’s Hospital, University of Helsinki, Helsinki University Hospital, Helsinki, Finland
4Department of Radiology, University of Helsinki and Helsinki University Hospital, Helsinki, Finland
5Department of Diagnostic Radiology, Oulu University Hospital and Research Unit of Medical Imaging, Physics, and Technology Medical Research Center Oulu, University of Oulu, Oulu, Finland
6Kuopio Pediatric Research Unit, University of Eastern Finland and Kuopio University Hospital, Kuopio, Finland
7Department of Clinical Radiology, University of Eastern Finland and Kuopio University Hospital, Kuopio, Finland
8Department of Pediatrics and Adolescent Medicine, Turku University Hospital, Turku University, Turku, Finland
9Department of Pediatrics and Adolescence, University of Helsinki and Helsinki University Hospital, Helsinki, Finland
10Department of Women’s and Children’s Health, Uppsala University, Uppsala, Sweden
11Medical Research Center Oulu, Department of Physical and Rehabilitation Medicine, University of Oulu and Oulu University Hospital, Oulu, Finland
12Finnish Institute of Occupational Health, Oulu, Finland
13Rehabilitation Services of South Karelia Social and Health Care District, Lappeenranta, Finland
Format: article
Version: published version
Access: open
Online Access: PDF Full Text (PDF, 2.1 MB)
Persistent link:
Language: English
Published: Springer Nature, 2023
Publish Date: 2023-09-20


Background: Childhood brain tumor (BT) survivors have an increased risk of treatment-related late effects, which can reduce health-related quality of life and increase morbidity. This study aimed to investigate lumbar disc degeneration in magnetic resonance imaging (MRI) in adult survivors of radiotherapy-treated childhood BT compared to age and sex-matched population controls.

Methods: In this cross-sectional comparative study, 127 survivors were identified from hospital registries. After a mean follow-up of 20.7 years (range 5–33.1), 67 survivors (mean age 28.4, range 16.2–43.5) were investigated with MRI and compared to 75 sex-matched population-based controls. Evaluated MRI phenotypes included Pfirrmann grading, intervertebral disc protrusions, extrusions, and high-intensity-zone-lesions (HIZ). Groups were also compared for known risk factors of lumbar intervertebral disc (IVD) degeneration.

Results: Childhood BT survivors had higher Pfirrmann grades than controls at all lumbar levels (all p < 0.001). Lumbar disc protrusions at L4-5 (p = 0.02) and extrusions at L3-4 (p = 0.04), L4-5 (p = 0.004), and L5-S1 (p = 0.01) were significantly more common in the BT group compared to the control. The survivor cohort also had significantly more HIZ-lesons than the controls (n=13 and n=1, p=0.003). Age at diagnosis was associated with lower degree of IVD degeneration (p < 0.01). Blood pressure correlated with IVD degeneration (P < 0.05).

Conclusions: Signs of early disc degeneration related to tumor treatment can be seen in the IVDs of survivors. Disc degeneration was more severe in children treated in adolescence.

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Series: BMC musculoskeletal disorders
ISSN: 1471-2474
ISSN-E: 1471-2474
ISSN-L: 1471-2474
Volume: 24
Issue: 1
Article number: 441
DOI: 10.1186/s12891-023-06509-4
Type of Publication: A1 Journal article – refereed
Field of Science: 3126 Surgery, anesthesiology, intensive care, radiology
3123 Gynaecology and paediatrics
Funding: Open Access funding provided by University of Helsinki including Helsinki University Central Hospital. This work was supported by Special State Grants for Health Research in the Department of Pediatrics and Adolescence, Oulu University Hospital, Finland; the Väre Foundation for Pediatric Cancer Research, Finland; the Foundation of Päivikki and Sakari Sohlberg, Finland; the Foundation of Arvo and Lea Ylppö, Finland; the Foundation for Pediatric Research, Finland; the Foundation of Emil Aaltonen, Finland; the Foundation of Thelma Mäkikyrö, Finland; the Cancer Foundation of Northern Finland; the Foundation of Alma and K.A. Snellman, Finland; the Foundation of Märta Donner, Finland (to T.R.); and the Cancer Society of Finland (to A.H, H.R., M.O.)
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