Objectives
The purpose of this manuscript is to review the current literature on osteoradionecrosis
of the cervical spine (C-ORN) and to summarize the risk factors, presenting symptoms
and management strategies of this rare condition.
Study Design
A systematic review of the literature on C-ORN was completed using PubMed. Nineteen
articles met criteria; 97 patient cases were identified. Statistical analysis was
completed from the patient cases.
Results
Of the analyzed patients, 72% are male and 28% are female with an average age of 57.7
years. Nasopharyngeal carcinoma was the most common initial diagnosis (72%). Thyroid
and other lower neck cancers were associated with a later onset of C-ORN compared
with other cancers. C-ORN more commonly occurred in the clivus to C2 (55.3%, P = .004). Onset of C-ORN significantly differed for men (n = 6.99 years) and women
(n = 17.5 years) (P = .022).
Conclusion
C-ORN can be a devastating complication of head and neck radiation therapy. C-ORN
is associated with nasopharyngeal carcinoma, and most commonly affects the area of
the clivus to cervical vertebrae C2. Cancers of the lower neck and female sex are
associated with later onset. Initial presentation ranges from asymptomatic to severe
neurologic deficits; the degree of intervention should be congruent with the severity
of presenting symptoms. As long-term survival of patients with head and neck cancer
increase, this complication may become more prevalent.
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Article info
Publication history
Published online: September 07, 2022
Accepted:
August 27,
2022
Received in revised form:
July 23,
2022
Received:
May 5,
2022
Identification
Copyright
© 2022 Elsevier Inc. All rights reserved.
