Conservative management of osteoradionecrosis

Wong, Jason; Wood, Robert E.; McLean, Michael

doi:10.1016/s1079-2104(97)90287-0

Cited by 140 publications

(60 citation statements)

References 42 publications

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“…Vertebral bony complications of these lesions require surgical management with a high risk of mechanical and infectious complications. In addition to the importance of early detection of ORN, permitting one to avoid surgery in some cases [16], it is important to eliminate a possible recurrent tumor or radio-induced cancer and to thoroughly consider surgical strategy, based upon understanding of this disorder.…”

Section: Resultsmentioning

confidence: 99%

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

Kouyoumdjïan

Gille²,

Aurouer³

et al. 2009

Eur Spine J

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A case description and a review of the literature. To report a case of deformity secondary to cervical vertebral osteoradionecrosis (ORN) associated with severe wound complications and review the pertinent medical literature. The incidence of deformity after ORN is rare and its association with extensive damage of soft tissues makes surgical treatment difficult. The spine surgeon should be aware of this to adapt the evaluation and surgery and be prepared to manage the numerous potential complications. A case of post-irradiation symptomatic kyphosis involving ORN of C5-C6 is reported. Failure of the anterior approach surgery was observed, and the secondary course was marked by the development of substantial cutaneous necrosis associated with severe and extensive post-irradiation cutaneous and muscular atrophy. Failure of the anterior approach surgery justified the use of posterior stabilization. Secondary destabilization of the posterior fixation at the cervico-thoracic junction required extension of the osteosynthesis to the middle thoracic region. Extensive posterior stabilization permitted obtaining reliable mechanical control of the radio-induced kyphosis with a 3-year follow-up. Wound freshening and covering with well-vascularized tissue was used to fill dead spaces and helped prevent soft-tissue complications after revision surgery. Radio-induced kyphotic deformity is an important entity. Surgeons should be aware of the complications that can lead to further deformity. Corrective procedures are also at high risk for mechanical, atrophic and infectious complications. Surgical repair strategies should be based on thorough comprehension and work-up of the disorder.

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Section: Resultsmentioning

confidence: 99%

“…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]. Nonetheless, the description of three types proposed by Marx is still useful.…”

Section: Discussionmentioning

confidence: 99%

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

Kouyoumdjïan

Gille²,

Aurouer³

et al. 2009

Eur Spine J

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“…A differential diagnosis is osteoradionecrosis (ORN), a slow-healing radiation-induced ischemic necrosis of the bone with associated soft-tissue necrosis of variable extent, which occurs in up to 57% of patients after irradiation of head and neck cancer [14,15]. Since osteomyelitis and osteodiscitis are proposed to represent infectious complications of underlying ORN [16], patient 1 possibly initially suffered from this.…”

Section: Discussionmentioning

confidence: 99%

Severe Pain Due to Paraspinal Abscess Formation in Two Patients with Squamous-Cell Carcinoma of the Head and Neck after Multimodal Treatment Including Cetuximab

et al. 2018

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Background: Patients with squamous-cell carcinoma of the head and neck (SCCHN) on palliative therapy usually have a bad prognosis and suffer from various symptoms. With increasing use of targeted agents in cancer patients at the end of life, the correct assignment of therapy-related symptoms becomes increasingly difficult as cancer-related symptoms usually increase as well. Case Report: We report on 2 cases of patients with SCCHN who received multimodal treatment including palliative therapy with cetuximab. Both patients developed severe thoracic and cervicothoracic pain following treatment. In both cases, extensive paraspinal abscess formation proved to be the underlying cause. One patient was treated conservatively; the other one had to undergo surgical intervention. Conclusions: Awareness of multifaceted therapy-related complications is mandatory when patients receive multimodal treatment including targeted therapies. Unexplained pain syndromes in this context should raise suspicions concerning possible infectious complications and should lead to early use of magnetic resonance imaging.

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“…ORN sometimes becomes difficult to diagnose due to its long incubation period after the radiation or due to its unusual site and presentation. Wong et al 9 defined ORN as the slow-healing, radiation-induced ischaemic necrosis of bone associated with soft tissue necrosis of variable extent occurring in the absence of local primary tumour necrosis, recurrence or metastatic disease. ORN is classified into three types as proposed by Marx with type 1 developing quickly after radiation therapy, type 2 develops late however after a traumatic event and type 3 occurs spontaneously between 6 months and 3 years after radiation therapy 10.…”

Section: Discussionmentioning

confidence: 99%

Secondary atlanto-odontoid osteoarthritis with osteoradionecrosis of upper cervical spine mimicking metastasis

2013

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Osteoradionecrosis (ORN) is a known entity in patients with head and neck malignancy treated by radiotherapy. Involvement of mandible (0.8-37%) and maxilla (2-11%) is quiet common but upper cervical spine involvement is rare. One needs to have a high index of suspicion for the diagnosis of ORN after radiotherapy in the head and neck region. It may mimic either metastasis or an infection and needs histopathology to make definitive diagnosis. We reported the successful treatment of a patient with ORN involving upper cervical spine by posterior decompression and stabilisation. In addition, a new technique of reaching the odontoid process from posterior aspect for biopsy has been described.

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Conservative management of osteoradionecrosis

Cited by 140 publications

References 42 publications

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

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

Severe Pain Due to Paraspinal Abscess Formation in Two Patients with Squamous-Cell Carcinoma of the Head and Neck after Multimodal Treatment Including Cetuximab

Secondary atlanto-odontoid osteoarthritis with osteoradionecrosis of upper cervical spine mimicking metastasis

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