Abstract
BackgroundDHS is characterized by chin-on-chest deformity and devastatingly impedes activities of daily living in affected individuals. There is a paucity of literature about the pathophysiology of DHS including knowledge about spinal sagittal alignment. We conducted this study to clarify the relationship between cervical sagittal alignment and global sagittal balance in DHS.MethodsThis is a retrospective radiographic study of a case series of DHS. Forty-one patients with diagnosed DHS were enrolled. Measurements were made using lateral standing radiograph.ResultsC2–C7 sagittal vertical axis (SVA) was estimated as 52.0 ± 2.4 mm. Among sagittal parameters, C7–S1 SVA positively correlated with C2–C7 angle (C2–C7 A) (r = 0.33). For the correlations between C7 and S1 SVA and C2–C7 A, both logistic and linear regression models were used to determine the threshold for C2–C7 A value responsible for global sagittal balance. C2–C7 A of − 15.0 and 6.0 were predicted by logistic and linear regression models and were considered responsible for the occurrence of global positive imbalance. Therefore, we divided into two groups, namely, cervical kyphosis group (C type) and diffuse kyphosis group (D type) by median value of C2–C7 A. Enlarged thoracic kyphosis and global positive imbalance were observed in D type compared to C type.ConclusionC2–C7 A exhibited correlations with cervical balance and also with global balance. There should be various type of thoraco-lumbar alignment in DHS.Graphic abstractThese slides can be retrieved under Electronic Supplementary Material.
Highlights
Dropped head syndrome (DHS) is characterized by chin-onchest deformity which is caused by severe extensor muscle weakness and is passively correctable with neck extension1 3 Vol.:(0123456789)European Spine Journal (2020) 29:413–419 with normal passive neck range of motion [1]
After obtaining institutional review board approval, a retrospective analysis of radiographic profiles was performed for the patients who presented to our department with chinon-chest symptoms which were correctable in the supine position
Forty-one patients who were not found to have an underlying neurological condition and whose condition was diagnosed as isolated neck extensor myopathy (INEM) were included in this study: DHS may be confounded by a broad range of differential diagnosis such as Parkinson’s disease [4], and INEM is considered to cause the chin-on-chest symptom in the absence of specific abnormality [5, 6]
Summary
European Spine Journal (2020) 29:413–419 with normal passive neck range of motion [1] This functional deformity arising from disability to balance the position of the head in standing or sitting posture impedes the quality of life of affected individuals significantly by inflicting various degrees of neck pain, difficulty in horizontal gaze, possible neurological symptoms, dysphagia or ambulation distress resulting in reduction in activities of daily living, and social interactions [2, 3]. The primary aim of the present study was to clarify the characteristics in sagittal alignment of DHS through radiographic measurements. For the correlations between C7 and S1 SVA and C2–C7 A, both logistic and linear regression models were used to determine the threshold for C2–C7 A value responsible for global sagittal balance. There should be various type of thoraco-lumbar alignment in DHS
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