title: Neurologic late effects associated with radiologic evidence of vertebral osteoradionecrosis after salvage laryngectomy: A syndrome associated with survivors of laryngeal and hypopharyngeal cancer.
abstract: Delayed nonspecific 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.
  
  
  
  We conducted a retrospective case series of 6 patients presenting from 2003 to 2012 with a history of laryngeal or hypopharyngeal squamous cell carcinoma (SCC) who underwent radiotherapy (RT) or chemoradiotherapy (CRT) followed by salvage laryngectomy.
  
  
  
  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 the onset of posterior neck pain. Five patients required urgent decompression. Three patients developed quadriplegia. The disease-specific mortality was 50%.
  
  
  
  There is a syndrome of late neurological effects after RT, salvage surgery, and pharyngeal instrumentation that is associated with high morbidity and mortality. © 2016 Wiley Periodicals, Inc. Head Neck 38:1187-1193, 2016.
authors.affiliation: Department of Otolaryngology-Head and Neck Surgery, University of Michigan, Ann Arbor, Michigan.
authors.forename: Andrew J
authors.initials: AJ
authors.lastname: Rosko
authors.affiliation: Department of Otolaryngology-Head and Neck Surgery, University of Michigan, Ann Arbor, Michigan.
authors.forename: Matthew E
authors.initials: ME
authors.lastname: Spector
authors.affiliation: Department of Otolaryngology-Head and Neck Surgery, University of Michigan, Ann Arbor, Michigan.|Midwest ENT Specialists, Woodbury, Minnesota.
authors.forename: Garrett R
authors.initials: GR
authors.lastname: Griffin
authors.affiliation: Department of Radiation Oncology, University of Michigan, Ann Arbor, Michigan.|Department of Radiation Oncology, Emory University, Atlanta, Georgia.
authors.forename: Jeffrey M
authors.initials: JM
authors.lastname: Vainshtein
authors.affiliation: Department of Radiation Oncology, University of Michigan, Ann Arbor, Michigan.
authors.forename: Jae
authors.initials: J
authors.lastname: Lee
authors.affiliation: Department of Otolaryngology-Head and Neck Surgery, University of Michigan, Ann Arbor, Michigan.
authors.forename: Carol R
authors.initials: CR
authors.lastname: Bradford
authors.affiliation: Department of Otolaryngology-Head and Neck Surgery, University of Michigan, Ann Arbor, Michigan.
authors.forename: Mark E P
authors.initials: ME
authors.lastname: Prince
authors.affiliation: Department of Otolaryngology-Head and Neck Surgery, University of Michigan, Ann Arbor, Michigan.
authors.forename: Jeffrey S
authors.initials: JS
authors.lastname: Moyer
authors.affiliation: Department of Medical Oncology, University of Michigan, Ann Arbor, Michigan.
authors.forename: Francis P
authors.initials: FP
authors.lastname: Worden
authors.affiliation: Department of Radiation Oncology, University of Michigan, Ann Arbor, Michigan.
authors.forename: Avraham
authors.initials: A
authors.lastname: Eisbruch
authors.affiliation: Department of Otolaryngology-Head and Neck Surgery, University of Michigan, Ann Arbor, Michigan.|Department of Otolaryngology-Head and Neck Surgery, University of Toronto, Toronto, Ontario, Canada.
authors.forename: Douglas B
authors.initials: DB
authors.lastname: Chepeha
mesh_terms: D000368:Aged; D001416:Back Pain / Q000000981:diagnostic imaging / Q000209:etiology; D002294:Carcinoma, Squamous Cell / Q000401:mortality / Q000473:pathology / Q000628:therapy; D005260:Female; D005500:Follow-Up Studies; D006258:Head and Neck Neoplasms / Q000401:mortality / Q000473:pathology / Q000628:therapy; D006801:Humans; D007012:Hypopharyngeal Neoplasms / Q000401:mortality / Q000473:pathology / Q000628:therapy; D007822:Laryngeal Neoplasms / Q000401:mortality / Q000473:pathology / Q000628:therapy; D007825:Laryngectomy / Q000379:methods; D008279:Magnetic Resonance Imaging / Q000379:methods; D008297:Male; D008875:Middle Aged; D019547:Neck Pain / Q000000981:diagnostic imaging / Q000209:etiology; D009364:Neoplasm Recurrence, Local / Q000000981:diagnostic imaging / Q000401:mortality / Q000532:radiotherapy* / Q000601:surgery*; D009422:Nervous System Diseases / Q000000981:diagnostic imaging / Q000209:etiology*; D010025:Osteoradionecrosis / Q000000981:diagnostic imaging* / Q000503:physiopathology; D010611:Pharyngectomy / Q000009:adverse effects / Q000379:methods*; D018714:Radiotherapy, Adjuvant / Q000009:adverse effects; D012189:Retrospective Studies; D018570:Risk Assessment; D016879:Salvage Therapy / Q000009:adverse effects / Q000379:methods*; D012494:Sampling Studies; D013131:Spine / Q000000981:diagnostic imaging / Q000473:pathology; D000077195:Squamous Cell Carcinoma of Head and Neck; D017741:Survivors; D013577:Syndrome; D013997:Time Factors; D016896:Treatment Outcome
keywords: head and neck cancer; late effects; myelopathy; osteoradionecrosis; salvage laryngectomy