Osteoradionecrosis of the Cervical Spine: An Analysis of the Literature

Published:September 07, 2022DOI:



      : 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.


      : A systematic review of the literature on C-ORN was completed using PubMed. Nineteen articles that met criteria; Ninety-seven patient cases were identified. Statistical analysis was completed from the patient cases.


      : 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 as compared to other cancers. C-ORN more commonly occurred in the clivus to C2 (55.3%, p=0.004). Onset of C-ORN significantly differed for males (n=6.99 years) and females (n=17.5 years) (p=0.022).


      : 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 gender are associated with later onset. Initial presentation ranges from asymptomatic to severe neurological deficits; degree of intervention should be congruent with severity of presenting symptoms. As long term survival of head and neck cancer patients increase, this complication may become more prevalent.
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