Radiation and Radiculopathy

[ADTMan]

Can radiation for prostate cancer cause radiculopathy? Anyone else experiencing this?

[Tall_Allen]

Is this spinal radiation of spinal metastases? If the tumor being treated is large and has invaded the soft tissue, the vertebrae can collapse when the met is gone. You may want to ask for a neurological consult before treatment.

[ADTMan in reply to Tall_Allen]

Just HDR brachytherapy and 25 IMRT treatments to the pelvis for high risk prostate cancer. Maybe the field is near the sciatic nerve or L5-S1 nerve roots?

[Tall_Allen in reply to ADTMan]

Radiation has little effect on nerves.

[SeosamhM in reply to ADTMan]

It need not be just associated with bone collapse. My C2 collapsed after treatment, resulting in some permanent nerve impingement - not only by the new geometry of the vertebrae, but via fibrosis. This is essentially disorganized tissue that grew in and around the tumor site (think scarring) and is called “radiation induced fibrosis” - RIF.

See: ncbi.nlm.nih.gov/pmc/articl...

In the words of the researchers, fibrosis “reduces tissue compliance”, i.e., like all scarring, RIF makes an area inflexible. The authors state that “RIF usually occurs 4–12 months after radiation therapy and progresses over several years. It affects almost every part of the body that is exposed to radiation.”

This “several years” progression was news to me - I thought the longer out I was from radiation, the better the recovery. Not necessarily so.

While radiation therapy is unlikely to directly cause permanent nerve damage, it is entirely conceivable that RIF can “strangle” or bind a nerve. Is it truly radiculopathy? Does it matter? I dunno, and only our neurologists know for sure! 😉

Good luck! - Joe M

[Drandma in reply to SeosamhM]

My husband had SBRT to the C2 in May. He is now experiencing pain in the same area and some tingling in his fingers on one side. An X-ray revealed no fracture. Could he be experiencing what you are referring to?

[SeosamhM in reply to Drandma]

Absolutely. As I understand it, most fibrosis is not dense enough to clearly appear on x-ray (it can occasionally calcify and look bone-like). However, your husband's symptoms could also be the start of a disc herniation. Were his vertebra in-line? "X-rays can show a change in the height of the disc space or a shift in a vertebra's position but cannot show a herniation itself."

My suggestion is to clearly track his tingling fingers - when does it happen, how strong is it (1 = barely noticeable, 10 = numb/strong pain), what is he doing when it occurs, and does anything make it worse/better. You need to emphasize this symptom with his healthcare providers. Bring up the term "neuropathy" to get his "finger tingling" into medical speak.

Get a referral to a spine specialist regardless - oncologists and GPs won't do. Even if his symptoms are manageable, monitoring your husband's c-spine is now a forever thing after SBRT (it is for me). If the tingling is constant, no matter the level, push hard for an appointment sooner rather than later.

[Drandma in reply to SeosamhM]

this is his X-ray report. I’m assuming the disc disease may be from radiation? We see the doctor on Tuesday

Report

[Volcanologist in reply to ADTMan]

The biopsy or the emplacement/insertion of the HDR tubes, markers, or spacer may have damaged or irritated some nerves. There are a lot of nerves attached to the prostate.

[Hidden]

L5 might be at risk with complete lymph node radiation. I remember being told the common iliac are around L4 and L5, and RO will work around those.

env.go.jp/en/chemi/rhm/basi...

The link supports TAs statement

[j-o-h-n]

To all the laypeople who read/post here.

From Dear Old Uncle Googie,

What Is Radiculopathy ? Commonly referred to as a pinched nerve, radiculopathy is injury or damage to nerve roots in the area where they leave the spine. This condition can affect anyone and can be the result disc degeneration, disc herniation or other trauma.

You're welcome.

Note, if uncle Googie asks you to pull any one of his fingers, under any and all circumstances, DO NOT.

Good Luck, Good Health and Good Humor.

j-o-h-n Sunday 09/24/2023 2:57 PM DST

[Don_1213 in reply to j-o-h-n]

Thank you j-o-h-n ! Now I have one more medical malady to add to my list of maladies. The list is almost (but not quite) catching up with my list of medications.

What'a life eh?

[j-o-h-n in reply to Don_1213]

You're welcome and Me <----- humming to myself......... "Life is just a bowl of strawberries 𝄞𝄫♫♪♬♩♭"......

Catching up to your medications? Famous Mexican expression : "say hey Jose, no way today or any day, okay?"...

What a life eh? <---- ditto.

Good Luck, Good Health and Good Humor.

j-o-h-n Sunday 09/24/2023 10:19 PM DST

[slpdvmmd]

Is it radiculopathy or neuropathy?? Radiculopathy specifically means compression or impingement of the nerve root near or at the foramen where it leaves the spine. Neuropathy refers to more distal injury. I have not personally seen pelvic plexus neuropathy after radiation, but it was listed as a complication on my consent form for pelvic radiation. I have seen brachial plexus neuropathy after radiation for head and neck cancer, or breast cancer where the plexus was in the field. While not common pain is significant. Since I did microvascular surgery as part of my hand practice I was involved on more than one occasion in trying to treat brachial plexus neuropathy by external neurolysis (removal of surrounding scar) and placement of an omental free flap to the area. There was improvement in some of the patients in my experience. So a long way to say yes radiation can affect major peripheral nerves resulting in neuropathy, in addition to secondary mechanical effects by bony collapse of vertebra resulting in impingement on nerve roots resulting in radiculopathy.

[ADTMan in reply to slpdvmmd]

Thank you for your thoughtful reply. The neurologist who did the EMG and nerve conduction study a few days ago said the nerves were "OK" but there was a problem at L5-S1. So, I am assuming its radiculopathy.

[slpdvmmd in reply to ADTMan]

That would be supportive of radiculopathy and imaging would be the next step.