Table 1.
Patients with cervical spine complications after NPC treatment
| No. | Patient | NPC treatment | Elapsed time (years) | Complication | Symptoms | Treatment | Outcome |
|---|---|---|---|---|---|---|---|
| 1 | M/55 years | Irradiation × 2 courses (60 Grays each) | 1 | C4/5 infective spondylitis | Incidental finding on X-ray | Antibiotics | Recovered |
| 2 | M/42 years | Irradiation × 2 courses | 2 | Pyogenic meningitis and odontoid ORN, C1 epidural abscess | Headache and fever | C1 anterior arch removal and debridement, antibiotics (ciprofloxacin and clindamycin) | C1/2 subluxation requiring PSF 1 year later |
| 3 | M/45 years | Irradiation × 2 courses (40 Grays each) | 3 | C1/2 infective spondylitis | Neck pain, stiffness, palm numbness | Augmentin | Stiff neck |
| 4 | F/56 years | Irradiation | 11 | C1/2 abscess with cord compression | Neck pain and fever | Anterior transoral decompression, clindamycin and metronidazole | Died of meningitis and pneumonia during same hospitalization |
| 5 | M/49 years | Irradiation × 2 courses (60 Grays each) | 2 | C2/3 infective spondylitis | Neck pain, no neurology | Clindamycin | Recovered |
| 6 | F/58 years | Irradiation | 19 | C2 erosion | Neck pain, no neurology | Conservative | Died 2 years later of pneumonia |
| 7 | M/55 years | Irradiation × 2 courses (68 Grays each) | 1 | C7 osteonecrosis | Neck pain, no neurology | Conservative | Recovered |
| 8 | M/51 years | Irradiation | 22 | Odontoid process erosion, C1/2 subluxation | Neck pain, no neurology | Halo vest | Stiff neck |
| 9 | F/51 years | Irradiation | 17 | C2–3 osteomyelitis and C2–4 ORN Perforated nasopharyngeal wall |
Incidental finding on FU MRI | ASF C2–C4 and PSF (occipital to C6), antibiotics (imipenem/cilastatin, vancomycin, fluconazole) SCM myocutaneous flap |
Recovered |
| 10 | M/42 years | Irradiation | 11 | C5–6 ORN with instability | Left C5–6 weakness | ASF C4–6 | Mild neck pain but stiff |
| 11 | M/52 years | Irradiation (76 Grays) | 8 | Retropharyngeal abscess, C1/2 spondylitis and pathological fracture | Neck pain | Halo vest and augmentin for 3 months | Recovered and removed halo at 3 months |
| 12 | M/53 years | Irradiation × 2 courses and nasopharyngectomy | 1 | C1–6 epidural abscess Persistent infection and posterior pharyngeal defect |
Neck pain, RUL weakness, fever | Right C2–6 hemilaminectomy and antibiotics (augmentin and levofloxacin for 3 months) Augmentin |
Life-long antibiotics |
| 13 | F/60 years | Irradiation × 2 | 11 | C1/2 osteomyelitis and posterior pharyngeal defect | Fever | Augmentin | Life-long antibiotics |
| 14 | M/46 years | Irradiation | 11 | C1/2 subluxation and C2 osteomyelitis | Neck pain | Ertapenem for 6 weeks | Resolved neck pain |
Elapsed time: time between last NPC treatment (irradiation or surgery) and onset of complication
ORN osteoradionecrosis