Dropped Head Deformity due to Cervical Myopathy

Gerling, Michael C.; Bohlman, Henry H.

doi:10.1097/brs.0b013e31817f1f8b

Cited by 46 publications

(14 citation statements)

References 19 publications

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“…DCS is thought to be the results of cervical structural decompensation [ 21 , 22 ]. For some cases of (DCS) with flexion of the cervical vertebra, posterior neck muscles might be stretched and weaker than in the neutral and extension position, which might lead to an increased risk of developing anterior cervical sagittal imbalance, as decompensated cervical structures might be unable to provide adequate compensatory action to maintain the T1 slope, resulting in larger T1 slope in the patients with DCS [ 23 , 24 ].…”

Section: Discussionmentioning

confidence: 99%

Thoracic Inlet Parameters for Degenerative Cervical Spondylolisthesis Imaging Measurement

Wang

Zhu

et al. 2018

Med Sci Monit

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BackgroundThe aim of this study was to explore the diagnostic value of sagittal measurement of thoracic inlet parameters for degenerative cervical spondylolisthesis (DCS).Material/MethodsWe initially included 65 patients with DCS and the same number of health people as the control group by using cervical radiograph evaluations. We analyzed the x-ray and computer tomographic (CT) data in prone and standing position at the same time. Measurement of cervical sagittal parameters was carried out in a standardized supine position. Multivariate logistic regression analysis was performed to evaluate these parameters as a diagnostic index for DCS.ResultsThere were 60 cases enrolled in the DCS group, and 62 cases included in the control group. The T1 slope and thoracic inlet angle (TIA) were significantly greater for the DCS group compared to the control group (24.33±2.85º versus 19.59±2.04º, p=0.00; 76.11±9.82º versus 72.86±7.31º, p=0.03, respectively). We observed no significant difference for the results of the neck tilt (NT), C2–C7 angle in the control and the DSC group (p>0.05). Logistic regression analysis and receiver operating characteristic (ROC) curve revealed that preoperative T1 slope of more than 22.0º showed significantly diagnostic value for the DCS group (p<0.05).ConclusionsPatients with preoperative sagittal imbalance of thoracic inlet have a statistically significant increased risk of DCS. T1 slope of more than 22.0º showed significantly diagnostic value for the incidence of DCS.

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Section: Discussionmentioning

confidence: 99%

Thoracic Inlet Parameters for Degenerative Cervical Spondylolisthesis Imaging Measurement

Wang

Zhu

et al. 2018

Med Sci Monit

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“…However, as it was clearly demonstrated in the current case, this formulation did not work and despite the plumb line falling posterior to manubrium, C2 to C7 instrumentation was insufficient and our construction failed. Therefore, it seems that it is better to extend the construct to the upper thoracic spine in all the patients who suffer from dropped head syndrome in isolation or as a combined pathology [ 2 , 3 , 14 , 17 – 19 ], in particular with consideration of the natural course of INEM which might be the progression of isolated myopathy to the muscles of the upper thoracic spine with time [ 18 ].…”

Section: Discussionmentioning

confidence: 99%

“…However, extension to the cranium was gradually eliminated after description of C2-C1 transarticular screw and C2 pedicle screws [ 2 , 3 , 13 , 14 , 17 – 19 ]. Gerling and Bohlman in 2008 reported nine cases of DHS in the context of INEM that were managed with posterior instrumented fusion [ 18 ]. The surgical constructs for all patients spanned C2 to upper thoracic levels.…”

Section: Discussionmentioning

confidence: 99%

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Cervical Spondylotic Myelopathy Secondary to Dropped Head Syndrome: Report of a Case and Review of the Literature

Rahimizadeh

Soufiani

Rahimizadeh

2016

Case Reports in Orthopedics

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The dropped head syndrome (DHS) is a disabling condition caused by severe weakness of the neck extensor muscles causing progressive reducible kyphosis of the cervical spine and the inability to hold the head up. Weakness can occur in isolation or in association with a generalized neuromuscular disorder. Isolated cases are owed to the late onset of noninflammatory myopathy designated as INEM, where persistent chin to chest deformity may gradually cause or aggravate preexisting degenerative changes of the cervical spine and ultimately result in myelopathy. In review of the literature, we could find only 5 cases, with no unique guidelines to address the management of these two concomitant pathologies. Herein, a 69-year-old man who had developed cervical myelopathy 2 years after being affected by isolated dropped head syndrome is presented. Chin to chest deformity and cervical myelopathy were managed through three-level anterior cervical discectomy and fusion (ACDF) combined with decompressive cervical laminectomy and stabilization with C2 to C7 pedicle screw-rod construct. At 4-month follow-up, despite recovery in patient's neurological status, flexion deformity reappeared with recurrence of dropped head due to C7 pedicle screws pull-out. However, this was successfully managed with extension of the construct to the upper thoracic levels.

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“…Treatment results with physical therapy, massage and acupuncture are inconsistent in cases series reports, 2 , 5 , 6 and most studies show little improvement with non-surgical management. 3 , 5 , 7 A collar can help the patient to maintain horizontal gaze and eye contact, and facilitate activities of daily living, although there are problems with compliance to the collar, skin pressure lesions and possible worsening of muscular weakness with prolonged use. 2 , 6 The goal of the surgical management of dropped-head syndrome is to improve quality of life by correcting the deformity, decompressing of neural elements when necessary and promoting long-term stabilization, 8 reating patients for whom conservative measures failed or for those who do not have treatable conditions as a cause for the dropped-head.…”

Section: Introductionmentioning

confidence: 99%

Surgical Correction of Severe and Fixed Chin-on-Chest Deformity

et al. 2018

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Objective:To describe a successful surgical treatment for the challenging severe and fixed chin-on-chest deformity due to isolated neck extensor myopathy (INEM).Background data:INEM is an idiopathic cause of dropped head syndrome (DHS) that results in severe cervicothoracic kyphosis, defined as chin-on-chest deformity. The existing literature on surgical management is limited, with outcomes ranging from poor to excellent. INEM may present to the spinal surgeon for consideration of surgical management.Methods:The authors present a technique that uses a staged posterior and anterior approach combined with osteotomies and corpectomy to correct the severe and fixed deformity. A state of the art anterior and posterior instrumentation system was used.Results:At the three-months follow-up, there was good deformity correction and the patient's satisfaction was high, with no neurological deterioration occurring.Conclusions:The technique illustrated in this study represents a successful option to treat this debilitating deformity. More evidence is needed to set up a definitive algorithm for the management of this condition. Level of evidence IV, Case Report.

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Dropped Head Deformity due to Cervical Myopathy

Cited by 46 publications

References 19 publications

Thoracic Inlet Parameters for Degenerative Cervical Spondylolisthesis Imaging Measurement

Thoracic Inlet Parameters for Degenerative Cervical Spondylolisthesis Imaging Measurement

Cervical Spondylotic Myelopathy Secondary to Dropped Head Syndrome: Report of a Case and Review of the Literature

Surgical Correction of Severe and Fixed Chin-on-Chest Deformity

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