C7 Vertebral Pathological Compressive Fracture after Radiotherapy for Esophageal Cancer: A Case Report.

Vertebral compression fractures (VCF) after radiation therapy (RT) are uncommon, particularly in the mid- and lower cervical spine. Surgical management of symptomatic cases can be challenging. Here, we report the case of a 63-year-old woman with radiculomyelopathy and C7 VCF. The patient presented with neck pain and bilateral hand numbness without osteoporosis. Four years previously, she had been cured of esophageal cancer through endoscopic surgery and RT without chemotherapy. Imaging revealed a pathological C7 vertebral body fracture with kyphotic deformity. Symptomatic VCF was diagnosed. Because of concerns regarding complications with an anterior approach, posterior-only decompression and fixation were performed. Intraoperative biopsy at C7 vertebra confirmed a diagnosis of avascular necrosis without metastasis. Fixation was performed by inserting lateral mass screw at C5-, 6 and pedicle screw at T1-, 2, connected by a rod. A multipoint screw was used to enhance rostral stability. The symptoms were alleviated postoperatively, and the patient remained well at 2-year follow-up.