Osteoradionecrosis of the subaxial cervical spine following treatment for head and neck carcinomas

A. S. Khorsandi, Henry Kangming Su, Waleed Fouad Mourad, M. L. Urken, M. S. Persky, C. L. Lazarus, A. S. Jacobson

Research output: Contribution to journalArticle

7 Citations (Scopus)

Abstract

Objective: To study MRI and positron emission tomography (PET)/CT imaging of osteoradionecrosis (ORN) of the subaxial cervical spine, a serious long-term complication of radiation therapy (RT) for head and neck cancers that can lead to pain, vertebral instability, myelopathy and cord compression. Methods: This is a single-institution retrospective review of patients diagnosed and treated for ORN of the subaxial cervical spine following surgery and radiation for head and neck cancer. Results: We report PET/CT imaging and MRI for four patients, each with extensive treatment for recurrent head and neck cancer. Osteomyelitis (OM) and discitis are the end-stage manifestations of ORN of the subaxial spine. Conclusion: ORN of the subaxial spine has variable imaging appearance and needs to be differentiated from recurrent or metastatic disease. Surgical violation of the posterior pharyngeal wall on top of the compromised vasculature in patients treated heavily with RT may pre-dispose the subaxial cervical vertebrae to ORN, with possible resultant OM and discitis. MRI and PET/CT imaging are complimentary in this setting. PET/CT images may be misinterpreted in view of the history of head and neck cancer. MRI should be utilized for definitive diagnosis of OM and discitis in view of its imaging specificity. Advances in knowledge: We identify the end-stage manifestation of ORN in the sub-axial spine on PET/CT and MRI to facilitate its correct diagnosis.

Original languageEnglish (US)
JournalBritish Journal of Radiology
Volume88
Issue number1045
DOIs
StatePublished - Jan 1 2015

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Osteoradionecrosis
Spine
Neck
Positron-Emission Tomography
Head
Head and Neck Neoplasms
Discitis
Carcinoma
Osteomyelitis
Radiotherapy
Therapeutics
Cervical Vertebrae
Spinal Cord Diseases
History
Radiation
Pain

ASJC Scopus subject areas

  • Radiology Nuclear Medicine and imaging

Cite this

Khorsandi, A. S., Su, H. K., Mourad, W. F., Urken, M. L., Persky, M. S., Lazarus, C. L., & Jacobson, A. S. (2015). Osteoradionecrosis of the subaxial cervical spine following treatment for head and neck carcinomas. British Journal of Radiology, 88(1045). https://doi.org/10.1259/bjr.20140436

Osteoradionecrosis of the subaxial cervical spine following treatment for head and neck carcinomas. / Khorsandi, A. S.; Su, Henry Kangming; Mourad, Waleed Fouad; Urken, M. L.; Persky, M. S.; Lazarus, C. L.; Jacobson, A. S.

In: British Journal of Radiology, Vol. 88, No. 1045, 01.01.2015.

Research output: Contribution to journalArticle

Khorsandi, AS, Su, HK, Mourad, WF, Urken, ML, Persky, MS, Lazarus, CL & Jacobson, AS 2015, 'Osteoradionecrosis of the subaxial cervical spine following treatment for head and neck carcinomas', British Journal of Radiology, vol. 88, no. 1045. https://doi.org/10.1259/bjr.20140436
Khorsandi, A. S. ; Su, Henry Kangming ; Mourad, Waleed Fouad ; Urken, M. L. ; Persky, M. S. ; Lazarus, C. L. ; Jacobson, A. S. / Osteoradionecrosis of the subaxial cervical spine following treatment for head and neck carcinomas. In: British Journal of Radiology. 2015 ; Vol. 88, No. 1045.
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