<b>SPINAL CORD</b> 

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Inflammation of the spinal cord nervous tissue is called myelitis. Damage to the spinal cord [myelopathy] can result in paralysis. The spinal cord may be inadvertently damaged while irradiating another organ or structure. However, spinal cord symptoms do not always mean late effect radiation damage, they sometimes are due to recurrent or metastatic tumor.

The incidence of permanent damage to the spinal cord as a complication of radiation therapy generally correlates positively with total radiation dose. However, several reports have indicated that fraction size is also an important factor in the development of late damage in normal tissue. Low fraction sizes appear to decrease the incidence of such damage, but increasing the number of doses per day increases the incidence of damage. If re-irradiation of the cord is necessary, latent time to myelopathy decreases following retreatment. The risk of myelitis that accompanies higher spinal cord irradiation doses must be weighed against the therapeutic gains.

<b>The Post-irradiation Lower Motor Neuron Syndrome</b>. Six men who had presented with testicular neoplasms and received irradiation were studied. A predominantly motor disorder affecting the legs ensued after variable and often prolonged latencies (3-25 years). However, all patients also developed mild sensory features either initially or on prolonged follow-up. Mild sphincter symptoms occurred in three of five surviving cases after a mean of 7.9 years. The first reported neuropathological study, uncomplicated by metastatic disease, of this area of the spinal cord showed a <b>radiation-induced vasculopathy.</b> Radiation exposure exceeded 40 Gy both in our series and in previous reports. <b>The natural history of this disorder is one of relentless deterioration occasionally punctuated by 1-2-year periods of stability. Post-irradiation lumbosacral radiculopathy is a more accurate name for this condition.</b> 

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