Surgical management of dropped head syndrome: A systematic review

Abstract

Background: Dropped head syndrome (DHS) is uncommon and involves severe weakness of neck-extensor muscles resulting in a progressive reducible cervical kyphosis. The first-line management consists of medical treatment targeted at diagnosing underlying pathologies. However, the surgical management of DHS has not been well studied. Methods: Here, we systematically reviewed the PubMed and Cochrane databases for DHS using the Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines. All relevant articles up to March 31, 2022, were analyzed. The patient had to be ≥18 years with DHS and had to have undergone surgery with outcomes data available. Outcomes measurements included neurological status, rate of failure (RF), horizontal gaze, and complications. Results: A total of 22 articles selected for this study identified 54 patients who averaged 68.9 years of age. Cervical arthrodesis without thoracic extension was performed in seven patients with a RF of 71%. Cervicothoracic arthrodesis was performed in 46 patients with an RF of 13%. The most chosen upper level of fusion was C2 in 63% of cases, and the occiput was included only in 13% of patients. All patients neurologically stabilized or improved, while 75% of undergoing anterior procedures exhibited postoperative dysphagia and/or airway-related complications. Conclusion: The early surgery for patients with DHS who demonstrate neurological compromise or progressive deformity is safe and effective and leads to excellent outcomes.

Occurrence of Dysphagia After Correction Surgery in the Cervical Spine for Dropped Head Syndrome

“…Therefore, surgical intervention can be applied when conservative treatment fails [ 10 ]. However, the requirement for extensive realignment of the cervical spine is associated with a high rate of complications [ 1 ]. Kurakawa et al reported that correction and posterior fixation of cervical kyphosis may cause a high percentage having postoperative complications such as C5 nerve palsy [ 13 ].…”

“…Most cases of postoperative dysphagia or airway-related complications after surgery for DHS were reported to be related to anterior procedure, not the alignment change [ 1 ]. However, realignment was certainly related to the dysphagia in our patient because immediate relief of the symptoms occurred after downgrading surgery which decreased the cervical lordosis.…”

“…Correction surgery for dropped head syndrome (DHS) is a challenging procedure that requires wide-ranged realignment of the cervical spine and is associated with a high rate of complications [ 1 ]. Postoperative difficulty in swallowing is a devastating complication that threatens life-support, similar to bladder and bowel disturbance.…”

“…The possible risk factors for postoperative dysphagia after anterior procedures include intraoperative esophageal traction [ 2 ], long operative time [ 3 ], multilevel surgery [ 2 ], soft tissue swelling [ 4 ], cervical plate use [ 3 ], and recurrent laryngeal nerve damage [ 5 ]. Most cases of postoperative dysphagia or airway-related complications after surgery for DHS were observed in patients treated with combined (anterior and posterior) approaches [ 1 ].…”

Association between the Phase Angle and the Severity of Horizontal Gaze Disorder in Patients with Idiopathic Dropped Head Syndrome: A Cross-Sectional Study

“…According to previous reports, IDHS patients show abnormal posture during standing and walking [ 3 , 4 ], have a slower gait than healthy subjects [ 3 ], and the severity of horizontal gaze disorder is associated with the patient’s gait speed [ 5 ]. Furthermore, while there have been reports on surgical treatment [ 6 ] and rehabilitation [ 7 ] for the treatment of IDHS, no effective treatment modality has been established. However, some case series and interventional studies reported that IDHS symptoms improved due to programs that include lower extremity or whole-body exercises [ 7 , 8 , 9 ].…”