A Case of Pyogenic Spondylitis and Epidural Abscess after Chemoradiotherapy for Hypopharyngeal Cancer

Osteomyelitis is one of the most severe late complications of radiation therapy. The condition can arise from osteoradionecrosis and can be fatal if it occurrs in vertebrae. A 71-year-old woman, who had undergone chemoradiotherapy for hypopharyngeal cancer 6 months previously, presented with severe neck pain. An MRI examination revealed pyogenic spondylitis and an epidural abscess of the neck. Neurological disturbance in the extremities developed despite the administration of antibiotics for 5 days. Drainage and a laminectomy were performed to control the infection and to relieve spinal cord compression. The patient had no postoperative complications at 15 months after surgery. Previous case reports of osteomyelitis and epidural abscess following radiation therapy for head and neck cancer with surgical treatment tended to have a good clinical course. Severe neck pain and a limitation in the range of motion of the neck are considered to be serious clinical features of osteomyelitis. Since infection in the necrotic mucosa leads to pyogenic spondylitis, a repeated cultivation survey of the mucosa is nessesary for adequate antibiotics therapy. For osteomyelitis and epidural abscess following radiation therapy, immediate specific surgical treatment of the involved region is strongly suggested if antibiotics are not effective or spinal cord compression develops.