Cervicothoracic Arthrodesis: The Best Management for Dropped Head Syndrome, A Case Series

Abstract

The authors present two cases of Dropped Head Syndrome (DHS), a condition distinguished by the chin-on-chest deformity due to weakness of the posterior muscle group of the neck. This is a unimodal syndrome and is most common among individuals in their seventh and eighth decade of life, with an average age of around 75 years. DHS is more prevalent in women, with a 3:2 ratio compared with men. Our reports document the disease's natural progression, increasing kyphosis, and resistance to initial conservative treatments. Both patients reported functional limitations, as their ability to walk and eat without assistance was hindered by loss of the horizontal gaze and dysphagia. After these treatment failures, we utilized an arthrodesis approach to target the C2-T6 segments of the cervical-thoracic spine. All previous complaints were resolved, the deformity was reduced, and the patients regained their functional independence. The surgical approach is indeed more efficient, although the combination of both methods yielded even better clinical outcomes. Arthrodesis from C2 to the upper thoracic spine segments is considered the most appropriate surgical technique for maintaining subaxial spine movement. This is due to its excellent rate of correcting deformities, preserving horizontal gaze, and improving or maintaining a neurological state.

Resumo

Os autores apresentam 2 casos de síndrome da cabeça caída (SCC), um quadro destacado devido à presença da deformidade-queixo-no-peito, decorrido da fraqueza do grupo muscular do pescoço. A síndrome se apresenta de forma unimodal, sendo predominante entre a sétima e a oitava década de vida, com uma idade média de cerca de 75 anos. É mais predominante em mulheres, apresentando uma razão de 3:2 em relação aos homens. Em nossos relatos, evidenciamos a evolução natural da doença, por meio de uma cifose crescente ao longo dos anos resistente às terapias conservadoras iniciais. Ambos os pacientes apresentavam queixa de limitação funcional, devido à incapacidade de deambular e se alimentar sem auxílio, resultante da perda do olhar horizontal e da disfagia. Após essa falha, a conduta adotada foi a artrodese dos seguimentos cervico-torácicos da coluna, buscando os seguimentos C2-T6. Obteve-se resolução das queixas prévias, reduzindo a deformidade e reavendo a independência funcional dos pacientes. A abordagem cirúrgica é de fato mais eficiente, embora a combinação de ambos os métodos tenha produzido resultados clínicos ainda melhores. A artrodese de C2 até os segmentos superiores da coluna torácica é considerada a técnica cirúrgica mais adequada para manter o movimento subaxial da coluna. Isso se deve ao seu excelente índice de correção de deformidades, preservação do olhar horizontal e melhora ou manutenção do estado neurológico.

Keywords

dropped head syndrome - kyphosis and surgery

Palavras-chave

síndrome da cabeça caída - cifose e cirurgia

Publikationsverlauf

Eingereicht: 10. Oktober 2023

Angenommen: 21. Oktober 2024

Artikel online veröffentlicht:
27. März 2025

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