• Peter J Cundy, Kamalesh Venugopal, Georgia Antoniou, Francis Brooks, FreemanBrian J CBJCDepartment of Orthopaedic Surgery, Women's & Children's Hospital, Adelaide, South Australia, Australia.Centre for Orthopaedic and Trauma Research, University of Adelaide, South Australia, Australia., and Katina D'Onise.
• Department of Orthopaedic Surgery, Women's & Children's Hospital, Adelaide, South Australia, Australia.
• Spine. 2020 Sep 1; 45 (17): 1200-1207.

Study DesignSpinal surgery cohort.ObjectiveThe authors assess the risk of cancer in children who have undergone frequent radiographs and have metal implants for the treatment of spinal deformity.Summary Of Background DataConcerns have been raised regarding the cancer risk to children exposed to repeated radiological examinations as part of routine surveillance to monitor progression of spinal deformity. Additionally, there are reports of increased cancer risk in adults having joint replacement with metal implants causing raised metal ion levels in the blood.MethodsA large number of consecutive children undergoing instrumented spinal surgery since 1979 were examined for their development of malignancy. High quality data on all invasive cancers from the South Australian Cancer Registry and deaths were linked to the spinal surgery cohort with the calculation of standardized incidence ratios (SIRs) using the Quinquinquennium method.ResultsThe study cohort was formed by 865 children. The average follow-up time from date of surgery to either death or censoring date was 18 years with a maximum of 36 years. A total of 15,921 person years were examined. There was no increased rate of cancer in these patients. For the total cohort, the SIR was 1.00 (95% confidence interval [CI] 0.50-1.79). For females the SIR was 0.83 (95% CI 0.33-1.70) and for males the SIR was 1.33 (95% CI 0.36-3.40). The male SIR reflected an expected cancer incidence of three cases, when four cases were observed, and was not statistically significant.ConclusionThis study has found that radiation exposure and possible exposure to circulating metal ions as a result of routine instrumented spine surgery in children since 1979 is not associated with an increased risk of cancer in up to 36 years of follow up.Level Of Evidence2.

30 keywords...

hide…