The prevalence and impact of cervical spine pathologies in patients with nasopharyngeal carcinoma

Abstract

Introduction: Nasopharyngeal carcinoma (NPC) and its treatment can lead to cervical spine pathologies such as metastases, osteoradionecrosis (ORN) and infection. However, the occurrence rate and relationship with the ever-advancing technology of radiation therapy is largely unknown. Furthermore, the timing of diagnosis and outcomes of treatment have not been evaluated. Hence, the aim of this study is to determine the prevalence and impact of cervical spine pathologies in patients with NPC. Methodology: Cross-sectional study of all newly diagnosed NPC cases from 2007 to 2016 at a tertiary referral oncology and spine centre with minimum 1-year post-treatment follow-up. All cervical spine pathologies, their treatment and outcomes of NPC and cervical spine pathology were determined. Presentation, onset time and correlations of the cervical spine pathology with mortality and risk factors were also analysed. Results and Analysis: Cervical spine pathologies were seen in 8.9% of 605 verified NPC cases. New onset neck pain was seen in 5.3% of cases, symptomatic cervical spondylosis in 4.8%, cervical spine metastases in 2.5%, 0.8% for local tumour invasion, 0.7% each for cervical ORN and osteomyelitis, and 0.3% for radiculopathy and myelopathy. Cervical spine pathologies were associated with an increased risk (odds ratio of 2.73) in overall mortality. Cervical spine metastases, invasion, osteoradionecrosis and infection were associated with statistically significant higher risk of mortality (p=0.01-0.02). Discussion and Conclusion: Cervical spine pathologies in NPC patients are heterogenous but not uncommon. Neck pain is prevalent but is often benign. ORN and osteomyelitis of the cervical spine is uncommon but have large clinical implications including higher mortality with subtle presentations.