Endoscopic transnasal and transoral resection of the odontoid process and C1 combined with occipitocervical fusion for osteoradionecrosis of the upper cervical spine: a case report and literature review

• Published in: BMC neurology 2024-10, Vol.24 (1), p.421-6, Article 421
• Main Authors: Chen, Zhijie, Bi, Zhongsheng, Liu, Da, Deng, Bin, Lu, Ming, Zeng, Yongqin, Zhang, Xubiao, Lin, Tao
• Format: Article
• Language: English
• Subjects: Back surgery; Cancer therapies; Case Report; Cervical carcinoma; Cervical osteonecrosis; Cervical Vertebrae - diagnostic imaging; Cervical Vertebrae - surgery; Complications; Debridement; Dysphagia; Endoscopy; Endoscopy - methods; Female; Head & neck cancer; Head and neck cancer; Head and neck carcinoma; Humans; Literature reviews; Middle Aged; Nasopharyngeal carcinoma; Nasopharyngeal Neoplasms - complications; Nasopharyngeal Neoplasms - radiotherapy; Nasopharyngeal Neoplasms - surgery; Neck pain; Occipitocervical fusion; Odontoid process; Odontoid Process - diagnostic imaging; Odontoid Process - surgery; Osteoradionecrosis; Osteoradionecrosis - surgery; Pain; Patients; Postoperative; Radiation therapy; Radiotherapy; Range of motion; Spinal cord; Spinal Fusion - methods; Spine (cervical); Surgeons; Surgery
• ISSN: 1471-2377; 1471-2377
• DOI: 10.1186/s12883-024-03928-1

Osteoradionecrosis (ORN) of the upper cervical spine is a rare but severe complication of head and neck cancer radiotherapy. To raise awareness of this condition, we describe a patient with a history of nasopharyngeal carcinoma who developed ORN of the upper cervical spine and review the published literature reporting surgical management. A 59-year-old female patient with persistent neck pain for one month and limited range of neck motion who had undergone radiotherapy for nasopharyngeal carcinoma with a total dose of 69.96 Gy 15 years ago presented to our hospital. The patient underwent endoscopic transnasal and transoral resection of the odontoid process and C1 anterior arch, combined with occipitocervical fusion. To better understand surgical management of ORN of the upper cervical spine, the literature published in the PubMed, Ovid MEDLINE, and Embase databases was reviewed. Our patient experienced alleviation of cervical pain and did not exhibit any postoperative complications. Since 2005, 11 cases of surgical management of ORN of the upper cervical spine (including the present case) have been published. Basilar invagination and/or atlantoaxial subluxation were observed in 4 /11 cases. Endoscopic procedures were performed in 4/11 cases, and occipitocervical fusion was performed in 8 /11 cases. Endoscopic transnasal and transoral resection of the odontoid process and C1 anterior arch is a safe and effective treatment option for ORN of the upper cervical spine. Occipitocervical fusion is useful in patients with basilar invagination and atlantoaxial subluxation.