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Neurological Rehabilitation

The Silent Consequence: Unmasking Radiation-Induced Myelopathy After Therapy

Thursday, October 23, 2025
5:00 PM - 6:30 PM MT
Location: Open Kiosks
Has Audio

    Primary Author(s)

  • Panayotis Jusakos, MD

    Resident Physician
    One Brooklyn Health System/Kingsbrook Jewish Medical Center PM&R Program
    Brooklyn, New York

    • Poster Presenter(s)

  • Brandon Amirian, MD

    Resident Physician
    State University of New York (SUNY) Downstate Health Sciences Univ PM&R Program
    Brooklyn, New York

    • Co-Author(s)

  • MS

    Michael Sposito, MD

    Resident Physician
    One Brooklyn Health System/Kingsbrook Jewish Medical Center PM&R Program
    Latham, New York

  • CC

    Charlene Canales, DO

    Resident physician
    One Brooklyn Health System/Kingsbrook Jewish Medical Center PM&R Program
    Brooklyn, New York

  • Suha Qasem, MD

    Resident physician
    One Brooklyn Health System/Kingsbrook Jewish Medical Center PM&R Program
    Brooklyn, New York

  • DS

    Daniel Sanchez, MD

    Resident
    One Brooklyn Health System/Kingsbrook Jewish Medical Center PM&R Program
    Brooklyn, New York

  • MR

    Marc Ross, MD

    Chair Department of physical medicine and rehabilitation
    One Brooklyn Health
    New York, New York

Disclosure(s):
Panayotis Jusakos, MD: No financial relationships to disclose
Brandon Amirian, MD: No financial relationships to disclose
Suha Qasem, MD: No financial relationships to disclose
Case Diagnosis: Radiation-induced myelopathy (RM) secondary to palliative radiotherapy in a patient with light chain myeloma.

Case Description or Program Description: A 58-year-old male with a history of Light Chain Myeloma (R-ISS Stage 1), diagnosed two years prior, presented with progressive ambulation difficulties, right lower extremity weakness, saddle anesthesia, and bowel and bladder incontinence. He previously received induction therapy with RVD (bortezomib, lenalidomide, dexamethasone) and palliative radiotherapy to the thoracic spine one year prior. Over the past month, he developed worsening right lower extremity weakness, sensory deficits, and multiple episodes of bowel and bladder incontinence.

Setting: The patient was admitted for evaluation of progressive neurological decline.

Assessment/Results: MRI demonstrated a chronic pathologic T6 wedge compression fracture, abnormal marrow signal from T4 to T8 suggestive of post-radiation changes, and multilevel neural foraminal narrowing. Neurosurgical evaluation found no mechanical compression or instability requiring intervention. Neuroradiology suggested RM as the primary etiology of his symptoms.

Discussion (relevance): Radiation-induced myelopathy is a rare but serious complication of spinal radiation therapy, typically presenting months to years post-treatment. Pathophysiology involves endothelial injury and demyelination due to small vessel ischemia, often without clear imaging findings. This case highlights the importance of considering RM in patients with prior spinal radiation who develop neurological deficits, as symptoms such as progressive weakness, sensory loss, and bowel/bladder dysfunction are characteristic. The interplay of radiation effects, pathologic fractures, and prior treatments necessitates ongoing surveillance for delayed complications.

Conclusions: Recognizing RM as a potential cause of neurological decline is critical in patients with prior spinal radiation. A multidisciplinary approach involving oncology, neurosurgery, and rehabilitation is essential to optimize outcomes and mitigate long-term morbidity.