Isolated osteoradionecrosis of the dens mimicking metastasis of nasopharyngeal carcinoma after radiotherapy

Jung Shun Lee, Chih Ming Huang, I. Chun Yeh, Helen Hai Wen Chen, Jin Ching Lin, Hsing Hong Chen

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10 Citations (Scopus)


Nasopharyngeal carcinoma (NPC) is common in southern China, and radiotherapy remains the mainstay of treatment. A rare late complication of this treatment is the development of osteoradionecrosis (ORN), which seldom involves the cervical spine. We describe a 47-year-old female with undifferentiated carcinoma of the nasopharynx, stage II (T2N0M0), who had undergone radiotherapy 51 months prior, and complained of a twitching headache on neck flexion/extension. Imaging studies, including MRI and 18-fluoro-2-deoxyglucose positron emission tomography scan, suggested the diagnosis of cervical spinal metastasis. However, plasma Epstein-Barr virus DNA was undetectable, favoring absence of tumor recurrence. The patient underwent atlantoaxial sublaminar wiring for an unstable spine and a subsequent transoral biopsy, the histopathologic diagnosis of ORN. The postoperative clinical course was uneventful and follow-up MRI, 2 years later, revealed gradual resolution of the lesion. To our knowledge this is the first report of an isolated ORN lesion of the dens confirmed surgically in a patient with a history of previously treated NPC, a lesion at the cervical spine, and inconclusive imaging and biological marker results. We recommend that ORN be suspected until proven otherwise in a previously irradiated patient.

Original languageEnglish
Pages (from-to)1064-1066
Number of pages3
JournalJournal of Clinical Neuroscience
Issue number8
Publication statusPublished - 2010 Aug

All Science Journal Classification (ASJC) codes

  • Surgery
  • Neurology
  • Clinical Neurology
  • Physiology (medical)


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