Neurologic late effects associated with radiologic evidence of vertebral osteoradionecrosis after salvage laryngectomy: A syndrome associated with survivors of laryngeal and hypopharyngeal cancer

Abstract

Background Delayed non-specific posterior neck pain after pharyngeal instrumentation can be associated with a syndrome of rapidly progressive neurologic embarrassment. We present this cohort to help define the syndrome and aid in early detection. Methods Retrospective case series of 6 patients presenting from 2003 – 2012 with a history laryngeal or hypopharyngeal squamous cell carcinoma (SCC) who underwent radiation (XRT) or chemoradiation (CRT) followed by salvage laryngectomy. Results Posterior neck and upper back pain developed a mean of 27.5 days after instrumentation of the pharynx (reconstruction after laryngectomy or pharyngeal dilation). Myelopathy developed an average of 21.5 days after onset of posterior neck pain. Five patients required urgent decompression. Three patients developed quadriplegia. The disease specific mortality was 50%. Conclusion There is a syndrome of late neurological effects after radiation, salvage surgery and pharyngeal instrumentation that is associated with high morbidity and mortality.