Atlantoaxial Instability Complicating Radiation Therapy for Recurrent Nasopharyngeal Carcinoma

Abstract

Patients who have undergone local irradiation for nasopharyngeal carcinoma may be at risk for developing atlantoaxial instability.

Acute atlanto-axial post-operative subluxation following posterior C1/2 fusion

“…[72][73][74][75][76] Nevertheless, the Gallie fusion remains popular mainly because it is technically simpler than the Brooks technique, and because of concerns regarding risk of cord injury with passage of sublaminar wires 1;2;72;74;77;78 (this being required at both levels with the Brooks, rather than only at C1 with the Gallie technique). Also, 3 cases of delayed cord compression by sublaminar C1/2 cables after solid bony fusion (15,33, and 48 months post-operatively) have recently been reported by Sudo et al 79 This rare delayed complication would also be presumably less likely with the Gallie or interspinous methods than with the Brooks technique.…”

Cervical vertebral osteoradionecrosis: surgical management, complications and flap coverage—a case report and brief review of the literature

“…When it does occur, it is more typically located in the upper or lower jaw [7]. The involvement of cervical vertebrae appears to be rare and the existing reports are succinct [2,7,11]. Criteria used to define ORN have changed over time [3,8,16].…”

“…The often reported neurological symptoms may also involve several factors [14]. Osseous or ligamentous lesions [11], a potential source of deformity and instability can also lead to neurological decompensation caused by compression. In the present case, ORN was revealed by cervicobrachial pain with no accompanying myelopathy.…”

Cervical spine complications after treatment of nasopharyngeal carcinoma

“…Radiotherapy can lead to development of ORN but can also cause adjacent soft-tissue complications such as atlantoaxial instability due to the destruction of soft-tissue constraints [2]. The close proximity of nasal and oral secretions may also result in contamination and subsequent infection which can further impede wound healing.…”

“…ORN is a process of ischemic bone necrosis associated with soft-tissue necrosis in the absence of malignancy. The mandible is notorious for ORN but spine involvement has also been reported [2][3][4][5][6][7][8][9]. One study found that ORN occurs in 10-15 % of patients who underwent radiotherapy [4].…”