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. 2025 Jan 30;8(1):e70047.
doi: 10.1002/jsp2.70047. eCollection 2025 Mar.

The Cross-Sectional Areas and Anterior-Posterior Balance of the Cervical Paraspinal Muscles in Dropped Head Syndrome and Cervical Spondylotic Myelopathy: A Propensity Score-Matched Analysis

Takashi Sono  1 , Kenta Ijiri  1 , Kensaku Kakehi  1 , Soichiro Masuda  1 , Takayoshi Shimizu  1 , Koichi Murata  1 , Shuichi Matsuda  1 , Bungo Otsuki  1
Affiliations

The Cross-Sectional Areas and Anterior-Posterior Balance of the Cervical Paraspinal Muscles in Dropped Head Syndrome and Cervical Spondylotic Myelopathy: A Propensity Score-Matched Analysis

Takashi Sono et al. JOR Spine. .

Abstract

Introduction: Dropped head syndrome (DHS) is characterized by weakness of the neck extensor muscles. However, few studies have assessed the cross-sectional areas (CSAs) of the cervical paraspinal muscles (CPM) and their anterior-posterior balance in DHS. This study aimed to elucidate the pathognomonic findings of DHS by comparing the CSAs and anterior-posterior balance of the CPM in patients with DHS and cervical spondylotic myelopathy (CSM), using magnetic resonance imaging (MRI).

Methods: We compared the CSAs and anterior-posterior balance of the CPM in patients with DHS and CSM using MRI. Patients with CSM were selected in an age- and sex-matched manner, using the propensity score. The longus colli (LC) muscle was selected as the anterior muscle; and the semispinalis cervicis (SSC), splenius capitis (SC), and multifidus muscles (MM) were selected as the posterior muscles. We calculated LC/SSC, LC/SC, LC/MM, and LC/(SSC + SC + MM), as indicators of neck muscle balance.

Results: The DHS and the CSM cohort comprised 26 and 52 patients, respectively. Both cohorts had a mean age of 71-year-old. There were no significant differences in the CSAs and most of the indicators of neck balance between the two cohorts. However, the LC/SSC was significantly higher in the DHS cohort than that in the CSM cohort (40.3% and 29.1%, respectively; p < 0.01).

Conclusions: Our study highlights a unique anterior-posterior imbalance in the CPM of DHS patients, differing from CSM patients. Strengthening the SSC muscle could be a key to preventing DHS progression.

Keywords: Dropped head syndrome; anterior–posterior muscle balance; longus colli muscle; semispinalis cervicis muscle.

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Conflict of interest statement

The authors declare no conflicts of interest.

Figures

FIGURE 1
FIGURE 1
Magnetic resonance images depicting dropped head syndrome. Left and right images reveal the transverse relaxation time (T2)‐weighted sagittal, and axial images of the cervical spine (fifth/sixth cervical vertebral [C5/6] disc level), respectively. Magenta, red, green, and yellow, depict the longus colli, semispinalis cervicis, splenius capitis, and multifidus muscles, respectively.
FIGURE 2
FIGURE 2
Magnetic resonance images depicting cervical spondylotic myelopathy. Left and right images show the transverse relaxation time (T2)‐weighted sagittal, and axial images of the cervical spine (fifth/sixth cervical vertebral [C5/6] disc level), respectively. Magenta, red, green, and yellow, depict the longus colli, semispinalis cervicis, splenius capitis, and multifidus muscles, respectively.
FIGURE 3
FIGURE 3
Graphs showing the anterior–posterior balance of the cervical paraspinal muscles, using means and standard deviations. Each dot reveals the individual parameters: Cervical spondylotic myelopathy (CSM); and dropped head syndrome (DHS). LC, Longus colli; SSC, Semispinalis cervicis; SC, Splenius capitis; and MM, Multifidus muscles; NS, Not significant; *p < 0.05.
See this image and copyright information in PMC

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