Chin-On-Chest Deformity from High-Dose Head and Neck Radiation

Radiotherapy is routinely used as an adjuvant for surgical resection in a wide breadth of spinal oncology cases. Patients with head and neck cancers also routinely receive high-dose radiotherapy. Subsequent to such radiotherapy, patients can experience cervical kyphosis, which in the most severe cases can result in chin-on-chest deformity. This may be due to a combination of anterior column collapse (e.g., due to pathologic fracture) and failure of the posterior tension band, often secondary to radiation-induced paraspinal muscle fibrosis and atrophy. Surgical correction is guided by the severity, location, and flexibility of the deformity and may involve anterior, posterior, or circumferential approaches with a combination of interbody placement and osteotomy work. Surgical intervention is often morbid, with 40% of patients suffering intraoperative complications and over 50% experiencing perioperative complications. Therefore, thorough preoperative evaluation and patient counseling are essential to achieve an optimal outcome in this high-risk population. In the oncology population, there must additionally be the consideration of expected patient prognosis, as patients routinely require 12 months or longer to fully recuperate from surgery. Nevertheless, surgical correction of chin-on-chest deformity can lead to significant improvements in patient quality of life.