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

Abstract

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.

“Dropped head syndrome” in amyotrophic lateral sclerosis: A case report

“…In cases where the deformity is fixed and passive correction is not possible, or even in cases of failure of the aforementioned therapy, a surgical approach can be indicated for correction of the DHS, providing the patient with long-term stabilization [8] with posterior fusion, combined anteroposterior, and cervical pedicle subtraction osteotomy being some of the surgical options to be adopted. However, it is noteworthy that there is a limitation in the literature when it comes to the surgical approach to the syndrome, requiring further studies to better demonstrate the effectiveness of these procedures [11].…”