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

Abolfazl Rahimizadeh,Housain F Soufiani,Saghayegh Rahimizadeh

doi:10.1155/2016/5247102

Abolfazl Rahimizadeh, Housain F Soufiani + Show 1 more

Open Access

https://doi.org/10.1155/2016/5247102

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Abstract

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.

Highlights

Dropped head syndrome or head ptosis is a reducible flexion deformity of the neck that is caused from a weakness of the extensor muscles or increased tone of the flexor muscles of the neck resulting in the chin-on-chest deformity and at the extreme the patient will be unable to look straight ahead [1,2,3,4,5,6]
It was highlighted that the syndrome can be seen in isolation or in association with a variety of generalized neuromuscular disorders as well as radiotherapy of the neck for corresponding malignancies [1,2,3,4,5,6,7,8]
The isolated type of dropped syndrome is a disease of the elderly that is caused by noninflammatory myopathy restricted to the paraspinal muscles of the neck being described by Suarez and Kelly Jr. for the first time in 1992 [9]

Summary

Introduction

Dropped head syndrome or head ptosis is a reducible flexion deformity of the neck that is caused from a weakness of the extensor muscles or increased tone of the flexor muscles of the neck resulting in the chin-on-chest deformity and at the extreme the patient will be unable to look straight ahead [1,2,3,4,5,6]. Isolated dropped head syndrome proceeding cervical spondylotic myelopathy and their ultimate association is quite rare This combination was first described by Kawaguchi in 2004 and since only four more cases have been described in the literature [11,12,13,14]. A new case of cervical myelopathy developing two years after the appearance of dropped head syndrome, as a sequel of isolated neck extensor myopathy, is presented and a brief review of the literature on the condition is provided [11,12,13,14]

Case Report

Discussion