Surgical treatment for dropped head syndrome with cervical spondylotic amyotrophy: a case report

Abstract

Background: Dropped head syndrome (DHS) is a flexion deformity of the neck that is caused by severe weakness of the neck extensor muscles. DHS occurs in combination with not only neuromuscular disorders, but also cervical spondylosis. However, there are few reports of DHS complicated by cervical spondylotic amyotrophy (CSA). Here we report a case of DHS with CSA in a patient who underwent surgical treatment.

Case presentation: A 79-year-old man became aware of dropped head and gait disturbance in addition to the paralysis of his right upper extremity. At his initial visit, he had a severe chin-on-chest posture. Neurological examination revealed severe paralysis of deltoid, biceps, wrist extensor, finger flexor, extensor, and abductors, in addition to lower extremity spasticity. Nevertheless, sensory dysfunction was not observed. X-ray images showed severe kyphosis at the upper thoracic level. MRI and CT myelography findings revealed spinal canal stenosis at the level of C5-6 and C6 root compression of the right side. Motor neuron disease was excluded because of findings from electromyography. Therefore, we diagnosed this patient as having DHS with cervical spondylotic amyotrophy. A C2-Th5 posterior fusion with C3-C6 laminoplasty and C5-6 foraminotomy on the right side were performed. After surgery, the complaint of dropped head was improved significantly and bilaterally finger motion was improved slightly. His neck position was maintained at the final follow-up at about 1 year after surgery.

Conclusions: Despite the limitation of short-term follow-up, favorable results for the DHS were maintained in the present case. Surgical treatment for similar cases may be a feasible option, but surgery does have some complications.

Keywords: Cervical spondylotic amyotrophy; Dropped head syndrome; Spinal instrumented surgery.

Fig. 1

Photograph of the patient before surgery. a Before surgery. b At the final follow-up

Fig. 2

X-ray image before surgery. a Cervical X-ray lateral finding. White line is the center of gravity of the head-plumb line. b Whole spine X-ray lateral finding. White line is the C7-plumb line

Fig. 3

MRI and CT. a MRI T2-weighted imaging. Sagittal imaging showed spinal cord anterior indentation at the level of C5–6 (arrow). T2 high signal change was not observed. b CT myelography sagittal reconstruction imaging showed that the anterior indentation of spinal cord is because of ossification of the longitudinal ligament (arrow). c MRI T2-weighted imaging and CT myelography axial imaging at the level of C5–6 showing right side C6 nerve root compression (nerve root sleeve disappearance, arrow head) in addition to the spinal cord compression

Fig. 4

X-ray image at final follow-up