Skip to main content

Advertisement

Log in

Cervical spine complications after treatment of nasopharyngeal carcinoma

European Spine Journal Aims and scope Submit manuscript

Abstract

Purpose

Radiotherapy has been the mainstay treatment for nasopharyngeal carcinoma (NPC) and has achieved good disease control. However, irradiation is associated with potential complications such as osteoradionecrosis (ORN) and infection. There is sparse description in the literature of such complications and how they are best managed. The objectives of the study are: (1) to describe the complications at the cervical spine after surgical and radiotherapy treatment for NPC (2) to identify key principles in the diagnosis and treatment of these complications.

Methods

A retrospective review of all patients with cervical spine complications after radiation treatment and surgery for NPC treated in a tertiary referral center, since 1990.

Results

Fourteen patients with cervical spine ORN and infections were found with an average duration to diagnosis of 8.6 years. All 14 patients had mucosal and deep biopsies and none had tumor recurrence. Four patients had ORN, eight had osteomyelitis and two patients had both ORN and osteomyelitis.

Conclusions

Radiotherapy complications usually have delayed and subtle presentations. ORN progresses slowly and can often be treated conservatively. Infections should be treated aggressively with surgical debridement and the results are generally good. Patients should be regularly followed-up with transoral examination to assess the integrity of the posterior pharyngeal wall and imaging to assess for ORN. Pharyngeal defects raise concern for cervical spine infections. Coverage of pharyngeal defects in these patients is important to prevent recurrent infection.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Fig. 1
Fig. 2
Fig. 3
Fig. 4
Fig. 5
Fig. 6
Fig. 7

Similar content being viewed by others

References

  1. Rabin BM, Meyer JR, Berlin JW et al (1996) Radiation-induced changes in the central nervous system and head and neck. Radiographics 16(5):1055–1072

    PubMed  CAS  Google Scholar 

  2. Orr RD, Salo PT (1998) Atlantoaxial instability complicating radiation therapy for recurrent nasopharyngeal carcinoma. A case report. Spine (Phila Pa 1976) 23(11):1280–1282

    Article  CAS  Google Scholar 

  3. Lim AA, Karakla DW, Watkins DV (1999) Osteoradionecrosis of the cervical vertebrae and occipital bone: a case report and brief review of the literature. Am J Otolaryngol 20(6):408–411

    Article  PubMed  CAS  Google Scholar 

  4. Donovan DJ, Huynh TV, Purdom EB et al (2005) Osteoradionecrosis of the cervical spine resulting from radiotherapy for primary head and neck malignancies: operative and nonoperative management. Case report. J Neurosurg Spine 3(2):159–164

    Article  PubMed  Google Scholar 

  5. King AD, Griffith JF, Abrigo JM et al (2010) Osteoradionecrosis of the upper cervical spine: MR imaging following radiotherapy for nasopharyngeal carcinoma. Eur J Radiol 73(3):629–635

    Article  PubMed  Google Scholar 

  6. Kosaka Y, Okuno Y, Tagawa Y et al (2010) Osteoradionecrosis of the cervical vertebrae in patients irradiated for head and neck cancers. Jpn J Radiol 28(5):388–394

    Article  PubMed  Google Scholar 

  7. Kouyoumdjian P, Gille O, Aurouer N et al (2009) Cervical vertebral osteoradionecrosis: surgical management, complications and flap coverage—a case report and brief review of the literature. Eur Spine J 18(Suppl 2):258–264

    Article  PubMed  Google Scholar 

  8. Lee JS, Huang CM, Yeh IC et al (2010) Isolated osteoradionecrosis of the dens mimicking metastasis of nasopharyngeal carcinoma after radiotherapy. J Clin Neurosci Off J Neurosurg Soc Australas 17(8):1064–1066

    Article  Google Scholar 

  9. van Wyk FC, Sharma MP, Tranter R (2009) Osteoradionecrosis of the cervical spine presenting with quadriplegia in a patient previously treated with radiotherapy for laryngeal cancer: a case report. J Med Case Reports 3:7262

    Article  Google Scholar 

  10. Fernandez-Ruiz M, Lopez-Medrano F, Garcia-Montero M et al (2009) Intramedullary cervical spinal cord abscess by viridans group Streptococcus secondary to infective endocarditis and facilitated by previous local radiotherapy. Intern Med 48(1):61–64

    Article  PubMed  Google Scholar 

  11. Tang LM, Chen ST, Chang HS (1996) Tuberculous meningitis in patients with nasopharyngeal carcinoma. Scand J Infect Dis 28(2):195–196

    Article  PubMed  CAS  Google Scholar 

  12. Jin JY, Wen N, Ren L et al (2011) Advances in treatment techniques: arc-based and other intensity modulated therapies. Cancer J 17(3):166–176

    Article  PubMed  Google Scholar 

  13. Sanger JR, Matloub HS, Yousif NJ et al (1993) Management of osteoradionecrosis of the mandible. Clin Plast Surg 20(3):517–530

    PubMed  CAS  Google Scholar 

  14. Kakarala K, Richmon JD, Durand ML et al (2010) Reconstruction of a nasopharyngeal defect from cervical spine osteoradionecrosis. Skull Base Off J N Am Skull Base Soc 20(4):289–292

    Article  Google Scholar 

Download references

Conflict of interest

There are no conflicts of interest and no source of funding.

Author information

Authors and Affiliations

Authors

Corresponding author

Correspondence to Keith Dip-Kei Luk.

Rights and permissions

Reprints and permissions

About this article

Cite this article

Cheung, J.PY., Wei, W.I. & Luk, K.DK. Cervical spine complications after treatment of nasopharyngeal carcinoma. Eur Spine J 22, 584–592 (2013). https://doi.org/10.1007/s00586-012-2600-9

Download citation

  • Received:

  • Revised:

  • Accepted:

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s00586-012-2600-9

Keywords

Navigation