Skip to main page content
U.S. flag

An official website of the United States government

Dot gov

The .gov means it’s official.
Federal government websites often end in .gov or .mil. Before sharing sensitive information, make sure you’re on a federal government site.

Https

The site is secure.
The https:// ensures that you are connecting to the official website and that any information you provide is encrypted and transmitted securely.

Access keys NCBI Homepage MyNCBI Homepage Main Content Main Navigation
. 2024 Mar 15;49(6):385-389.
doi: 10.1097/BRS.0000000000004841. Epub 2023 Oct 4.

Contrast-enhanced Magnetic Resonance Imaging in Patients With Dropped Head Syndrome

Kenji Endo  1 , Hirosuke Nishimura, Yasunobu Sawaji, Takato Aihara, Hidekazu Suzuki, Takamitsu Konishi, Kyohei Nagayama, Kengo Yamamoto
Affiliations

Contrast-enhanced Magnetic Resonance Imaging in Patients With Dropped Head Syndrome

Kenji Endo et al. Spine (Phila Pa 1976). .

Abstract

Study design: This is a retrospective study of a consecutive case series of dropped head syndrome (DHS).

Objective: To identify the characteristic features of contrast-enhanced magnetic resonance imaging (MRI) in DHS patients.

Summary of background data: Isolated neck extensor myopathy DHS is thought to be caused by severe cervical extensor muscle weakness from age-related loss of elasticity. However, the MRI findings of the cervical extensor muscles in DHS patients have not yet been characterized.

Materials and methods: The subjects were 34 patients with isolated neck extensor myopathy DHS who underwent contrast-enhanced MRI within seven months after onset and 32 patients with age-matched cervical spondylosis or cervical soft-tissue tumor as controls. The presence of enhanced findings in the cervical extensor muscles, the involved cervical levels, and the characteristically enhanced shape of those muscles were evaluated using contrast-enhanced MRI.

Results: In the DHS group, the contrast-enhanced MRI showed pronounced enhancement at splenius capitis in 34 cases, rhomboid in 23 cases, semispinalis cervicis in seven cases, and levator scapulae in three cases. In the non-DHS group, none of those extensor muscles were enhanced. The enhanced pattern was butterfly shaped in 29 cases (85.3%) and linear in five cases (14.7%). All were located at the spinous process attachment at C6 or C7 in the DHS group. In the non-DHS group, seven cases presented an enhanced image of the spinous process, with C5-6 in one case, C6 in five cases, and C7 in one case.

Conclusions: In DHS, contrast-enhanced MRI showed intramuscular enhancement of the cervical extensor muscles, which was not present in non-DHS cases. The enhanced muscles included the splenius capitis muscle in all cases. These findings may be useful for developing a strategy for DHS treatment.

PubMed Disclaimer

Conflict of interest statement

The authors report no conflicts of interest.

References

    1. Sharan AD, Kaye D, Malveaux WMC, et al. Dropped head syndrome: etiology and management. J Am Acad Orthop Surg. 2012;20:766–74.
    1. Brodell JD, Sulovari A, Bernstein DN, et al. Dropped head syndrome: an update on etiology and surgical management. JBJS Rev. 2020;8:e0068.
    1. Katz J, Wolfe G, Burns D, et al. Isolated neck extensor myopathy—a common cause of dropped head syndrome. Neurology. 1996;46:917–21.
    1. Endo K, Kudo Y, Suzuki H, et al. Overview of dropped head syndrome (combined survey report of three facilities). J Ortop Sci Nov. 2019;24:1033–6.
    1. Endo K, Matsubayashi J, Sawaji Y, et al. Histopathological characteristics of cervical extensor tissue in patients with dropped head syndrome. Eur J Med Res. 2021;26:135.