Posterior Decompression and Fusion for Cervical Spondylodiscitis due to Osteoradionecrosis after Head-and-Neck Cancer Radiotherapy: Two Case Reports

Introduction: Cervical spondylodiscitis due to osteoradionecrosis (ORN) after head-and-neck cancer radiotherapy is a severe complication. However, there are few reports on the surgical treatment of this condition. Case Report: We report two cases of cervical spondylodiscitis due to ORN, which were successfully treated with posterior decompression and fusion. The first case was in a 73-year-old male patient with spondylodiscitis at C3–C5, due to ORN. A posterior fusion of the spine (C2–T1) was performed, and a biopsy was conducted at a site separate from the incision for fusion. The second case was in a 76-year-old female patient with spondylodiscitis due to C4–C7 ORN. Cervical posterior decompression and fusion (C2–Th2) were performed, and decompression (C5–6) was conducted through an incision separate from that for the fusion. An anterior approach was avoided in both cases because of radiation-induced tissue changes. For these two patients with cervical spondylodiscitis due to ORN, surgery resulted in an improvement of infection and neurological deficits by posterior spinal fusion, isolation from decompression or biopsy of the infected area, and antibiotic treatment. Conclusion: Posterior decompression and fusion are effective for spondylodiscitis in the cervical spine after head-and-neck radiotherapy, treating both infection and neurological deficits. Spinal fusion that avoids the level of the infected vertebral body and decompression from separate skin incision sites may prevent the spread of infection. An anterior approach should be avoided because the risk of esophageal perforation and posterior pharyngeal wall defects is high. Keywords: Cervical spondylodiscitis, osteoradionecrosis, radiotherapy, posterior fusion surgery.