{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,9,16]],"date-time":"2026-09-16T05:05:13Z","timestamp":1789535113415,"version":"build-2803163510"},"reference-count":12,"publisher":"Springer Science and Business Media LLC","license":[{"start":{"date-parts":[[2026,9,16]],"date-time":"2026-09-16T00:00:00Z","timestamp":1789516800000},"content-version":"tdm","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0"},{"start":{"date-parts":[[2026,9,16]],"date-time":"2026-09-16T00:00:00Z","timestamp":1789516800000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0"}],"funder":[{"DOI":"10.13039\/501100010029","name":"Taishan Scholar Foundation of Shandong Province","doi-asserted-by":"publisher","award":["20250512"],"award-info":[{"award-number":["20250512"]}],"id":[{"id":"10.13039\/501100010029","id-type":"DOI","asserted-by":"publisher"}]}],"content-domain":{"domain":["link.springer.com"],"crossmark-restriction":false},"short-container-title":["Strahlenther Onkol"],"abstract":"<jats:title>Abstract<\/jats:title>\n                  <jats:sec>\n                    <jats:title>Background<\/jats:title>\n                    <jats:p>Cervical spine osteoradionecrosis (ORN) is a\u00a0rare 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\u00a0case of cervical spine ORN occurring 7\u00a0years after postoperative adjuvant radiotherapy for laryngeal carcinoma.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Case presentation<\/jats:title>\n                    <jats:p>A\u00a070-year-old man with a\u00a0history of poorly controlled type\u00a02 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\u2013C7 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\u00a0diagnosis 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\u00a0deep 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.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusions<\/jats:title>\n                    <jats:p>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.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.1007\/s00066-026-02590-5","type":"journal-article","created":{"date-parts":[[2026,9,16]],"date-time":"2026-09-16T04:40:04Z","timestamp":1789533604000},"update-policy":"https:\/\/doi.org\/10.1007\/springer_crossmark_policy","source":"Crossref","is-referenced-by-count":0,"title":["Cervical spine osteoradionecrosis complicated by pyogenic spondylitis, quadriplegia, and fatal hemorrhage following postoperative radiotherapy for laryngeal carcinoma: a\u00a0case report"],"prefix":"10.1007","author":[{"given":"Dan","family":"Wang","sequence":"first","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Jingyan","family":"Wang","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Zhonglu","family":"Liu","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-9789-1318","authenticated-orcid":false,"given":"Xicheng","family":"Song","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"297","published-online":{"date-parts":[[2026,9,16]]},"reference":[{"key":"2590_CR1","doi-asserted-by":"crossref","unstructured":"Wang T et al (2026) Mitophagy activation for jawbone radiation injury therapy via angiogenesis\/osteogenesis-active nanozymes. Sci China Life Sci 69(7):2360\u20132375","DOI":"10.1007\/s11427-025-3104-4"},{"issue":"3","key":"2590_CR2","doi-asserted-by":"publisher","first-page":"487","DOI":"10.1002\/cncr.33948","volume":"128","author":"NS Treister","year":"2022","unstructured":"Treister\u00a0NS et\u00a0al (2022) Exposed bone in patients with head and neck cancer treated with radiation therapy: An analysis of the Observational Study of Dental Outcomes in Head and Neck Cancer Patients (OraRad). Cancer 128(3):487\u2013496","journal-title":"Cancer"},{"issue":"6","key":"2590_CR3","doi-asserted-by":"publisher","first-page":"471","DOI":"10.1016\/j.oraloncology.2010.03.017","volume":"46","author":"C Madrid","year":"2010","unstructured":"Madrid\u00a0C, Abarca\u00a0M, Bouferrache\u00a0K (2010) Osteoradionecrosis: an update. Oral Oncol 46(6):471\u2013474","journal-title":"Oral Oncol"},{"issue":"2","key":"2590_CR4","doi-asserted-by":"publisher","first-page":"135","DOI":"10.1001\/jamaoto.2025.4179","volume":"152","author":"F Yang","year":"2026","unstructured":"Yang\u00a0F et\u00a0al (2026) Osteoradionecrosis After Intensity-Modulated Radiation Therapy or Proton Therapy in Oropharyngeal Carcinoma. JAMA Otolaryngol Head Neck Surg 152(2):135\u2013143","journal-title":"JAMA Otolaryngol Head Neck Surg"},{"issue":"5","key":"2590_CR5","doi-asserted-by":"publisher","first-page":"283","DOI":"10.1016\/0278-2391(83)90294-X","volume":"41","author":"RE Marx","year":"1983","unstructured":"Marx\u00a0RE (1983) Osteoradionecrosis: a\u00a0new concept of its pathophysiology. 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Contemp Clin Dent 9(2):242\u2013248","journal-title":"Contemp Clin Dent"},{"issue":"2","key":"2590_CR8","doi-asserted-by":"publisher","first-page":"194","DOI":"10.1080\/00016480600818054","volume":"127","author":"KC Prasad","year":"2007","unstructured":"Prasad\u00a0KC et\u00a0al (2007) Osteomyelitis in the head and neck. Acta Otolaryngol 127(2):194\u2013205","journal-title":"Acta Otolaryngol"},{"key":"2590_CR9","doi-asserted-by":"publisher","DOI":"10.4076\/1752-1947-3-7262","volume":"3","author":"FC van Wyk","year":"2009","unstructured":"van Wyk\u00a0FC, Sharma\u00a0MP, Tranter\u00a0R (2009) Osteoradionecrosis of the cervical spine presenting with quadriplegia in a patient previously treated with radiotherapy for laryngeal cancer: a case report. J\u00a0Med Case Rep 3:7262","journal-title":"J Med Case Rep"},{"issue":"4","key":"2590_CR10","first-page":"345","volume":"71","author":"M Tanaka","year":"2017","unstructured":"Tanaka\u00a0M et\u00a0al (2017) Cervical Spine Osteoradionecrosis. 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