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Spinal Problems in Childhood Cancer Survivors

Some cancer treatments can cause the spine to curve abnormally.

Scoliosis and kyphosis are 2 spinal conditions that can happen. Both can be treated.

How the Spine Works

The spine or backbone is a group of bones stacked in a straight line down the middle of the back. It is held together with muscles and ligaments.

The spine has 3 three main functions:

  • Protect the spinal cord, nerve roots and several of the body's internal organs.
  • Provide structural support and balance to maintain an upright posture. 
  • Enable flexible motion.


Scoliosis occurs when the spine rotates to the side.

A healthy spine appears as a straight line when viewed from the back. With scoliosis, the spine curves like the letter "S" or "C."

Scoliosis is diagnosed when there is at least a 10-degree side-to-side curve on the X-ray.

Signs are:

  • Uneven shoulder blades
  • Uneven hips
  • Uneven waist
  • Leaning of the back to one side
  • Head not centered above hip bones
  • One leg longer than the other
Graphic showing a normal spine compared to a spine with scoliosis

Causes and Risk Factors for Scoliosis After Childhood Cancer Treatment

Scoliosis happens in many young people, especially teenagers. Often the cause is unknown.

Patients who have received certain types of radiation are at greater risk for uneven development of the muscles, bones, and soft tissues of the back.

Childhood cancer survivors at risk for scoliosis include those who had:

  • A tumor in or near the spine
  • Surgery involving the spine or chest. This does not include placement of a central line.
  • Radiation to the trunk or any area from the shoulders down to the pelvis. Radiation can lead to uneven development of the muscles, bones, and soft tissues of the back. The risk increases when:
    • The dose was 20 Gy or more
    • Radiation treatment area was to one half of the chest or abdomen
    • There was also surgery to the chest, abdomen, or spine


Kyphosis is an abnormal rounding of the upper part of the back. People with kyphosis may appear to be slouching or have a hump on their back. 

Kyphosis is confirmed when there is a 50-degree or higher curve on the X-ray.

Symptoms include:

  • Poor posture
  • Back pain
  • Muscle fatigue
  • Stiffness in the back
Graphic showing a normal spine compared to a spine with kyphosis

Causes and Risk Factors for Kyphosis After Childhood Cancer Treatment

People at risk for kyphosis include those who had:

  • A tumor in or near the spine
  • Surgery to the spine, chest, or upper abdomen (not including placement of a central line)
  • Radiation to the chest, upper abdomen, especially in doses of 20 Gy or more.
    • Radiation may cause the spinal ligaments to stretch, increasing the natural curve of the spine.
    • Radiation can also cause back muscles and ligaments to develop unevenly.

Treatments for Scoliosis and Kyphosis

If scoliosis or kyphosis is diagnosed, patients are usually referred to an orthopedic specialist.

Treatment for both conditions is usually handled in stages:

  • Observation. The curve will be closely monitored, particularly during puberty and other periods of rapid growth. If the curve doesn’t get worse, observation may be all that is necessary.
  • Brace. If the curve progresses, the next step is usually a plastic body brace. It can be worn underneath clothing to stop the curve from getting worse or help correct it.
  • Surgery. This is done in serious cases that can’t be managed with observation or bracing alone. 

What Survivors Can Do for Spinal Problems

Know Your Risks and Monitor Your Health

  • Know your risk of developing spinal problems. Ask your doctor if you have received treatments that increase your risk for spinal conditions.
  • Share a copy of your Survivorship Care Plan with health care providers. The plan includes details about your cancer treatment, including blood transfusions, and information about health problems that may occur because of your treatment.

Screening for Spinal Problems

  • Have regular check-ups that include checking for spine problems. Scoliosis and kyphosis can be found during a physical exam. An X-ray can confirm the diagnosis.
  • Talk with your health care provider if are concerned about the curve of your spine.

For more information, visit the Children’s Oncology Group Scoliosis and Kyphosis Health Link.

Reviewed: May 2020