Cervical spine osteoradionecrosis complicated by pyogenic spondylitis, quadriplegia, and fatal hemorrhage following postoperative radiotherapy for laryngeal carcinoma: a case report

Abstract Background Cervical spine osteoradionecrosis (ORN) is a rare but serious complication after head and neck radiotherapy. It may be complicated by secondary infection, leading to neurological impairment and severe vascular complications. We report a case of cervical spine ORN occurring 7 years after postoperative adjuvant radiotherapy for laryngeal carcinoma. Case presentation A 70-year-old man with a history of poorly controlled type 2 diabetes mellitus and hypertension had previously undergone partial laryngectomy and neck dissection followed by postoperative helical tomotherapy for glottic laryngeal carcinoma. Seven years later, he presented with neck pain, fever, and progressive weakness of all four limbs. Cervical CT and MRI showed destructive changes of the C4–C7 vertebral bodies, gas in the C5/6 intervertebral space and prevertebral soft tissues, and findings suggestive of infectious involvement. Blood culture yielded Streptococcus constellatus. A diagnosis of cervical spine ORN complicated by pyogenic spondylitis, cervical spinal cord injury, and quadriplegia was made. The patient underwent tracheotomy, neck exploration, incision and drainage of a deep neck abscess, and debridement of necrotic tissue. Although infection control and partial neurological improvement were achieved, he subsequently developed recurrent massive oral and nasal hemorrhage and ultimately died of hemorrhagic shock. Conclusions This case highlights the need for continued vigilance for delayed cervical spine ORN and secondary infection during long-term follow-up after head and neck radiotherapy. In patients presenting with new-onset neck pain, fever, or neurological deficits, early evaluation with CT, MRI, and, when vascular involvement is suspected, CTA should be performed to facilitate timely intervention.