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Case Reports
. 2022 Sep 14;7(5):e1037.
doi: 10.1097/PR9.0000000000001037. eCollection 2022 Sep-Oct.

Dropped head syndrome: report of a rare complication after multilevel bilateral cervical radiofrequency neurotomy

Harnek S Bajaj  1 , Andrew W Chapman  2
Affiliations
Case Reports

Dropped head syndrome: report of a rare complication after multilevel bilateral cervical radiofrequency neurotomy

Harnek S Bajaj et al. Pain Rep. .

Abstract

Introduction: Cervical radiofrequency neurotomy is a safe and relatively low-risk procedure commonly used to treat facet joint-mediated axial neck pain. Severe complications are extremely rare and can be avoided with proper technique and appropriate imaging guidance. This article describes the development and subsequent management of a case of dropped head syndrome after cervical radiofrequency neurotomy.

Methods: A 77-year-old man with cervicalgia, multilevel facet arthropathy, and a known kyphosis in the setting of cervical degenerative disk disease underwent successful conventional radiofrequency neurotomy to the bilateral C3, C4, and C5 medial branches. No immediate complications were noted.

Results: Six weeks subsequent to the procedure, the patient reported difficulty keeping his head erect, and physical examination revealed weakness of the cervical paraspinal musculature, with restriction of active extension to about neutral. A diagnosis of dropped head syndrome was made. The patient was successfully managed with temporary use of soft cervical collar and physical therapy for progressive range of motion and strengthening.

Discussion: Dropped head syndrome is a known, but likely underappreciated, complication of cervical radiofrequency neurotomy, with only 2 other cases reported and published in the literature to our knowledge. Mild cases may resolve with conservative management, but this is a potentially debilitating condition that we recommend should be routinely discussed during procedural consent for cervical radiofrequency neurotomy. Future studies should explore specific mitigating factors to reduce the risk of development of this possible complication.

Keywords: Case report; Cervical; Complication; Dropped head syndrome; RFA; Radiofrequency ablation; Radiofrequency neurotomy.

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Conflict of interest statement

The authors have no conflict of interest to declare.Sponsorships or competing interests that may be relevant to content are disclosed at the end of this article.

Figures

Figure 1.
Figure 1.
Intraoperative lateral fluoroscopic images depicting appropriate cannula placement at the right and left C3, C4, and C5 medial branches for radiofrequency neurotomy.
See this image and copyright information in PMC

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