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Dropped head syndrome: a treatment strategy and surgical intervention

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Abstract

Purpose

The pathology of dropped head syndrome (DHS) is diverse, and reports of surgery for DHS are scarce. We aimed to describe surgery for DHS and to investigate the surgical outcomes thereof.

Methods

We enrolled 40 consecutive patients (six males and 34 females; average age at surgery, 72.0 years) with DHS who underwent correction surgeries at a single institute. Short fusion (SF), with the extent of fixation mainly at the cervical region, was performed for 27 patients; long fusion (LF), involving the cervical and thoracic spine, for 13. Clinical and radiological outcomes were investigated, and factors analyzed using the Japanese Orthopedic Association Cervical Myelopathy Evaluation Questionnaire (JOACMEQ).

Results

All patients were able to gaze horizontally at the follow-up. Instances of five transient C5 palsy results, and five distal junctional kyphosis results were found, but no revisions were reported due to recurrence. Patients whose T1 slope-20° was smaller than the C2–7 angle postoperatively exhibited better clinical outcomes in the three domains of the JOACMEQ, regardless of the extent of fixation.

Conclusion

For cases where the T1 slope is relatively small, and approximately 10° of cervical lordosis is predicted to be obtained postoperatively, SF is appropriate. Alternatively, for cases with higher T1 slope, obtaining a cervical lordosis over 20° has a risk of postoperative complications. For such cases, it is an option to perform an LF involving the cervical and thoracic spine.

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Authors and Affiliations

  1. Department of Orthopedic Surgery, Kindai University Hospital, 377-2 Ohno-higashi, Osaka-Sayama, Osaka, 589-851, Japan

    Hiroshi Miyamoto, Terumasa Ikeda, Shingo Aoyama, Kensuke Toriumi & Masao Akagi

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  1. Hiroshi Miyamoto
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  2. Terumasa Ikeda
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  3. Shingo Aoyama
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  4. Kensuke Toriumi
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  5. Masao Akagi
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Correspondence to Hiroshi Miyamoto.

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The authors declare that they have no conflict of interest.

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The study was approved by the ethical committee of the institute (No. R02-041).

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Miyamoto, H., Ikeda, T., Aoyama, S. et al. Dropped head syndrome: a treatment strategy and surgical intervention. Eur Spine J 32, 1275–1281 (2023). https://doi.org/10.1007/s00586-023-07563-1

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  • DOI: https://doi.org/10.1007/s00586-023-07563-1

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