How would you best manage C-spine osteoradionecrosis?  

HBO, pentoxyfylline, vitamin E, and prayers. I can’t imagine surgery would be useful except as a last resort. I’m extrapolating from the mandible and maxilla. I don’t recall seeing an ORN of a cervical vertebra. Thankfully.

For brain radionecrosis, there are some case reports of Boswellia Serrata 2400 mg BID may be helpful. Not sure if it is worthwhile but a consideration.

I agree with @William M. Mendenhall. I have never seen ORN of the cervical vertebra in cases of vertebral invasion of disease and certainly in the absence of gross tumor recurrence. Pentoxyphylline (PoP), vitamin E & hyperbaric oxygen have varying levels of evidence and success but are modest as...