Dropped head syndrome with progressing cervical spondylotic myelopathy undergone anterior and posterior combined approach―two cases report and review of literature

Abstract

Dropped head syndrome is a rare symptom with inability of horizontal gaze or gait disturbance, resulting in a chin- on- chest deformity in the standing or sitting position. In past reports, dropped head syndrome may be caused by various disease. The authors present two cases of dropped head syndrome with progressing cervical myelopathy undergone by anterior and posterior combined cervical fixation. In the first case, a 70- year- old female was admitted with the chief complaint of a several- year history of progressing neck stooping in the standing position and numbness of limbs. In the second case, a 83- year- old female was admitted with a 9- month history of progressing spontaneous neck hanging and neck pain in standing position. She suffered from disturbance of hand skill movement 4 months before admission. Cervical X- ray of these cases revealed dynamic instability of the C4- 5 vertebra. The authors determined to undergo surgery of anterior and posterior combined cervical fixation for both patients. In both patients, postoperative course was uneventful and recurrence of dropped head syndrome has not been detected during 9 and 3 months of follow- up. Recently, some surgical cases of dropped head syndrome have been reported. The authors review literature of these cases and discuss surgical therapeutics of dropped head syndrome. Suitable surgery with preoperative deliberate consideration and postoperative close observation should be done for each cases with dropped head syndrome.