Dropped head syndrome after cervical laminoplasty: A case control study

Koda, Masao; Furuya, Takeo; Kinoshita, Tadahiko; Miyashita, Tetsuya; M, Ota; Maki, Satoshi; Ijima, Yasushi; Saito, Junya; Takahashi, Kazuhisa; Yamazaki, Masashi; Aramomi, Masaaki; Mannoji, Chikato

doi:10.1016/j.jocn.2016.03.027

Cited by 11 publications

(4 citation statements)

References 10 publications

(9 reference statements)

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“…3The precise definition of DHS has not been established, and the causes and alignment of DHS were diverse. 8,10,24,25 DHS is different from spodylotic cervical kyphosis, and cervical alignment of DHS is not stable and affected by extensor muscle fatigue. Therefore, it was difficult to define the recovery of DHS according to the duration of horizontal gaze and sagittal spinal alignment in X-ray.…”

Section: Discussionmentioning

confidence: 99%

Mode of onset of dropped head syndrome and efficacy of conservative treatment

Kusakabe

Endo

Sawaji

et al. 2020

J Orthop Surg (Hong Kong)

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Purpose: The initial treatment of dropped head syndrome (DHS) is basically nonsurgical, but the mode of onset of DHS and efficacy of conservative treatment have not been fully clarified. Methods: The subjects were 38 DHS patients without neuromuscular disease (11 men and 27 women, average age 74.5 years). Cervical collar, physical therapy, and temporary medication for cervical pain were provided for all DHS patients. The following parameters were measured on lateral global spine standing radiographs: sagittal vertical axis (SVA), cervical sagittal vertical axis, C2–C7 angle, first thoracic slope, thoracic kyphosis, lumbar lordosis, sacral slope, pelvic tilt, and pelvic incidence. According to the mode of onset of DHS, the subjects were classified into acute-onset group (<3 months) and chronic-onset group (≥3 months). Results: Acute- and chronic-onset DHS were observed in 20 and 18 patients, respectively. A history of cervical trauma was involved in nine and two cases of acute- and chronic-onset DHS, respectively. Acute-onset DHS included more balanced-SVA (B-SVA: −30 mm <SVA ≤40 mm) than chronic-onset DHS. In conservative cases, the recovery rate was better in acute-onset DHS with B-SVA. In acute-onset DHS treated conservatively, the recovery rate was significantly poor in cervical trauma cases. Conclusions: Acute-onset DHS includes more balanced SVA and a history of cervical trauma, while acute-onset DHS without a history of cervical trauma has better prognosis by conservative treatment. Surgical indications for DHS should be carefully determined, and sufficient conservative treatment is essential.

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Section: Discussionmentioning

confidence: 99%

Mode of onset of dropped head syndrome and efficacy of conservative treatment

Kusakabe

Endo

Sawaji

et al. 2020

J Orthop Surg (Hong Kong)

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“…Several reports have indicated favorable results of surgical treatment for DHS [ 8 ]. However, surgical treatment for DHS sometimes has complications for the adjusted segments [ 7 – 9 ]. Generally, DHS is classified as a flexible type in which the neck position can be corrected by passive head extension or a supine position, and a rigid type in which the neck position cannot be corrected by changing posture [ 10 ].…”

Section: Discussionmentioning

confidence: 99%

“…According to those reports, DHS occurs in combination with neuromuscular disorders such as noninflammatory myopathy, motor neuron disease, and Parkinson’s disease [ 1 – 6 ]. By contrast, there are several reports of DHS in combination with cervical spondylotic disorders such as cervical spondylotic myelopathy or DHS after cervical laminoplasty [ 7 ]. However, there are few reports of DHS complicated by cervical spondylotic amyotrophy (CSA) [ 1 ] and, to our knowledge, there are no reports of surgical treatment for this condition.…”

Section: Introductionmentioning

confidence: 99%

Surgical treatment for dropped head syndrome with cervical spondylotic amyotrophy: a case report

et al. 2018

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BackgroundDropped head syndrome (DHS) is a flexion deformity of the neck that is caused by severe weakness of the neck extensor muscles. DHS occurs in combination with not only neuromuscular disorders, but also cervical spondylosis. However, there are few reports of DHS complicated by cervical spondylotic amyotrophy (CSA). Here we report a case of DHS with CSA in a patient who underwent surgical treatment.Case presentationA 79-year-old man became aware of dropped head and gait disturbance in addition to the paralysis of his right upper extremity. At his initial visit, he had a severe chin-on-chest posture. Neurological examination revealed severe paralysis of deltoid, biceps, wrist extensor, finger flexor, extensor, and abductors, in addition to lower extremity spasticity. Nevertheless, sensory dysfunction was not observed. X-ray images showed severe kyphosis at the upper thoracic level. MRI and CT myelography findings revealed spinal canal stenosis at the level of C5–6 and C6 root compression of the right side. Motor neuron disease was excluded because of findings from electromyography. Therefore, we diagnosed this patient as having DHS with cervical spondylotic amyotrophy. A C2–Th5 posterior fusion with C3–C6 laminoplasty and C5–6 foraminotomy on the right side were performed. After surgery, the complaint of dropped head was improved significantly and bilaterally finger motion was improved slightly. His neck position was maintained at the final follow-up at about 1 year after surgery.ConclusionsDespite the limitation of short-term follow-up, favorable results for the DHS were maintained in the present case. Surgical treatment for similar cases may be a feasible option, but surgery does have some complications.

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“…The chin-on-chest deformity may cause various symptoms, including horizontal gaze difficulty, severe neck pain, dysphagia, neurological dysfunction due to nerve compression, and gait disturbance, leading to significant impairment in activities of daily living and social interactions [3]. There are many conditions related to the onset of DHS, such as systemic myopathies, neuromuscular diseases, and previous cervical spine surgery [4][5][6][7]. DHS can also develop without known background conditions.…”

Section: Introductionmentioning

confidence: 99%

Radiological features of cervical spine in dropped head syndrome: a matched case–control study

et al. 2021

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Purpose Dropped head syndrome (DHS) is presumably caused by focal myopathy in the cervical posterior muscles; however, distinguishable radiological features of the cervical spine in DHS remain unidentified. This study investigated the radiological features of the cervical spine in dropped head syndrome. Methods The records of DHS patients and age-and sex-matched cervical spondylotic myelopathy (CSM) patients were reviewed. Cervical spinal parameters (C2-7, C2-4, and C5-7 angles) were assessed on lateral cervical spine radiographs. Quantitative radiographic evaluation of cervical spine degeneration was performed using the cervical degenerative index (CDI), which consists of four elements: disk space narrowing (DSN), endplate sclerosis, osteophyte formation, and listhesis. Results Forty-one DHS patients were included. Statistically significant differences were noted between the upper and lower cervical spine in the sagittal angle parameters on the neutral, flexion, and extension radiographs in DHS group, whereas no significant differences were observed in CSM group. CDI comparison showed significantly higher scores of DSN in C3/4, C4/5, C5/6, and C6/7; sclerosis in C5/6 and C6/7; and osteophyte formation in C4/5, C5/6, and C6/7 in DHS group than in CSM group. Comparison of listhesis scores revealed significant differences in the upper levels of the cervical spine (C2/3, C3/4, and C4/5) between two groups. Conclusion Our results demonstrated that the characteristic radiological features in the cervical spine of DHS include lower-level dominant severe degenerative change and upper-level dominant spondylolisthesis. These findings suggest that degenerative changes in the cervical spine may also play a role in the onset and progression of DHS.

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Dropped head syndrome after cervical laminoplasty: A case control study

Cited by 11 publications

References 10 publications

Mode of onset of dropped head syndrome and efficacy of conservative treatment

Mode of onset of dropped head syndrome and efficacy of conservative treatment

Surgical treatment for dropped head syndrome with cervical spondylotic amyotrophy: a case report

Radiological features of cervical spine in dropped head syndrome: a matched case–control study

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