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Pedicle subtraction osteotomy for the treatment of chin-on-chest deformity in a post-radiotherapy dropped head syndrome: a case report and review of literature

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Abstract

Purpose

Chin-on-chest deformity is a rare and severe condition mostly related with ankylosing spondylitis, traumas and/or cervical spine surgery. We present a case of 69 years old woman with a rare form of chin-on-chest secondary to dropped head syndrome (DHS), developed after radiotherapy for Hodgkin disease. In addition, we reviewed the few publications about this specific condition; management and surgical treatment of DHS are discussed.

Methods

We performed a pedicle subtraction osteotomy (PSO) and stabilization through a posterior approach. Intraoperative monitoring using motor and somatosensory evoked potentials and wake-up test were carried out.

Results

At 19th month follow-up, the patient reported a significant improvement of cervical pain, dysphagia and respiratory difficulty and a complete restoration of the neurological impairment. The achieved correction was successful and the patient was very satisfied by the restoration of forward gaze.

Conclusions

DHS is a very rare post-radiotherapy complication; there is lack of evidences in literature about its management. The only definitive treatment seems to be surgical intervention. PSO is a valid therapeutic option when fixed chin-on-chest deformity occurs; although it is a demanding technique and it presents high rate of complications, the actual neurological monitoring methods provide more intraoperative safety.

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Authors and Affiliations

  1. Division of Orthopedic and Traumatology, University of the Study of Perugia, Hospital “S. Maria della Misericordia”, Via Ruggero Leoncavallo n.12, 06132, Perugia, Italy

    Luigi Caruso, Giuseppe Barone, Andrea Farneti & Auro Caraffa

Authors
  1. Luigi Caruso
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  2. Giuseppe Barone
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  3. Andrea Farneti
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  4. Auro Caraffa
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Correspondence to Giuseppe Barone.

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Caruso, L., Barone, G., Farneti, A. et al. Pedicle subtraction osteotomy for the treatment of chin-on-chest deformity in a post-radiotherapy dropped head syndrome: a case report and review of literature. Eur Spine J 23 (Suppl 6), 634–643 (2014). https://doi.org/10.1007/s00586-014-3544-z

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  • DOI: https://doi.org/10.1007/s00586-014-3544-z

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