Evaluation of Neck Disability Using Computed-Tomography in Head and Neck Cancer Survivors

Abstract

ObjectiveWe have previously reported that 55% of head and neck cancer survivors have neck disability. However, it is unclear what factors contribute to their neck disability. Our study aim is to determine if survivors with neck disability have evidence of cervical spine degenerative disease assessed by computed tomography (CT).Materials/MethodsCross-sectional analysis of patient-reported neck disability, prospectively collected on survivors of squamous cell carcinomas without recurrence or metastasis over one-year post-treatment. Neck disability and its impact on daily life was measured using the Neck Disability Index (NDI) and compared with cervical CT scans within 6 months. Scans were evaluated for degeneration of the disc and facet of the cervical vertebrae rated on a 5-point scale where 5 indicates more severe disease. Multivariable linear regression was used to analyze the association between NDI and radiographic findings.Results116 survivors of oropharyngeal carcinomas were identified, predominantly male (81.9%) with an average age of 62.8 ± 8.2 (range 43.8–81.4). Most survivors had advanced stage III-IVa cancer (94.0%) with treatment modalities including surgery (n=26, 52.0%), chemotherapy (n = 45, 90.0%), and radiation therapy (n = 49, 98.0%). Absence of neck disability was observed in 44.0% of survivors, 39.7% had mild disability, and 16.4% moderate disability. The time from treatment to clinic visit was an average of 3.1 ± 2.7 years (range 1.1–13.4). Multivariable analysis of NDI controlling for age, time since treatment, and treatment modality identified an inverse association between NDI and spinal degenerative disease examining cervical discs (−1.46 95% confidence interval (CI) [−2.86, −0.06], p = 0.041) and age (−0.24 95% CI[−0.40, −0.08], p = 0.004).ConclusionsOur study shows that neck impairment and pain in head and neck cancer survivors is not sufficiently explained by cervical degeneration related to age or trauma, supporting the theory that post-treatment neck disability occurs as a side effect of treatment. These results support the further assessment of structure and function of cervical musculature and degeneration following HNC treatment.

Proposal of a diagnostic algorithm for radiation-induced dropped head syndrome in long-term childhood cancer survivors based on a prospective study in a specialized clinical setting and a review of the literature

“…Analyzing the Neck Disability Index (NDI) scores, less than half of the patients (45.5%) showed no impairment, which corresponds well to former studies revealing similar values (44% with no impairment) in head and neck cancer survivors [22]. In other words, more than 50% of CCS exposed to neck RT indicated neck impairment and pain emphasizing the need for better awareness and management of neck disability even if no apparent radiation-induced DHS is diagnosed (yet).…”

“…In addition, CCS were divided into three groups based on the severity of their disability as measured by the achieved NDI score. For this purpose, the criteria used in [22] were applied. CCS with scores of 4 or less were assigned to the group with no disability.…”

Proposal of a diagnostic algorithm for radiation-induced dropped head syndrome in long-term childhood cancer survivors based on a prospective study in a specialized clinical setting and a review of the literature

“…Analyzing the Neck Disability Index (NDI) scores, less than half of the patients (37%) showed no impairment, which corresponds well to former studies revealing similar values (44% with no impairment) in head and neck cancer survivors (Harris et al 2022 ). In other words, more than 50% of CCS exposed to neck RT indicated neck impairment and pain emphasizing the need for better awareness and management of neck disability even if no apparent radiation-induced DHS is diagnosed (yet).…”

“…In addition, CCS were divided into three groups based on the severity of their disability as measured by the achieved NDI score. For this purpose, the criteria used in Harris et al ( 2022 ) were applied. CCS with scores of 4 or less were assigned to the group with no disability.…”