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Cervical myelopathy caused by dropped head syndrome

Case report and review of the literature

Kinya Nakanishi, Mamoru Taneda, Toshihisa Sumii, Tomonari Yabuuchi, and Norihiro Iwakura

I n dropped head syndrome, the patient’s head hangs forward when the body is in the erect or sitting position. Although commonly considered a benign condition by itself, dropped head syndrome limits activities of daily living because the patient can only look downward. The dropped head is primarily due to excessive tension in the anterior cervical muscles associated with multiple system atrophy, or in other cases from weakness or atrophy of the posterior cervical muscles. Dropped head syndrome may be caused by one of several neuromuscular disorders. The

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Takashi Fujishiro, Sachio Hayama, Takuya Obo, Yoshiharu Nakaya, Atsushi Nakano, Yoshitada Usami, Satoshi Nozawa, Ichiro Baba, and Masashi Neo

, even though the spinal canal is surgically expanded. 9 , 10 Second, when the kyphotic change progresses and sagittal balance in the cervical spine is disrupted, not only does neck pain worsen, but also health-related quality of life deteriorates. 11 , 12 Although severe sagittal imbalance after CLP is very rare, the so-called dropped head syndrome, which markedly complicates daily living, after CLP has been reported in the literature. 13 , 14 For these reasons, researchers have investigated the risk factors associated with the loss of CL after CLP, so that

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Bong Ju Moon, Justin S. Smith, Christopher P. Ames, Christopher I. Shaffrey, Virginie Lafage, Frank Schwab, Morio Matsumoto, Jong Sam Baik, and Yoon Ha

can lead to spinal deformities. 5 The abnormal posture that often accompanies PD may result in spinal deformity, such as camptocormia, antecollis (drop head syndrome), Pisa syndrome, and scoliosis. Antecollis has a reported prevalence of approximately 6% in PD, 2 , 6 and, when severe, the neck drop of antecollis can be markedly more pronounced relative to the expected flexed posture of the trunk and limbs. 30 This classic stooped appearance of PD may be associated with cervical malalignment in the setting of relatively normal global sagittal alignment, which can

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Seung-Jae Hyun, Ki-Jeong Kim, and Tae-Ahn Jahng

who underwent multilevel cervical instrumentation and fusion for a primary cervical kyphotic deformity. From 2015 to 2019, 23 consecutive patients (10 male, 13 female; mean age 56.2 ± 15.3 years) with a minimum 1-year follow-up were enrolled in the study. Patients diagnosed with primary cervical kyphosis, including chin-on-chest deformity, degenerative cervical sagittal imbalance, dropped-head syndrome, or iatrogenic cervical kyphosis, were included. The enrolled patients underwent surgery performed by three attending spine surgeons at a single academic institution

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Federico Micheli, María G. Cersósimo, and Fabian Piedimonte

D isturbance of posture may occur in a variety of neurological disorders and, occasionally, is the presenting or even the only sign observed. In most cases, the head, trunk, or both are bent forward (bent spine syndrome, dropped head syndrome). Camptocormia is a condition characterized by severe flexion of the thoracolumbar spine and knees, and passive drooping of both arms, which increases on walking and disappears when the supine position is assumed. It was first described in 1818 by Brodil and termed camptocormia by the French neurologist Souques in

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Lisa B. E. Shields, Vasudeva G. Iyer, Yi Ping Zhang, and Christopher B. Shields

, index, and little fingers. Her right arm remained weaker than her left arm. Her right thoracic area numbness had improved. Cervical MRI 3 months after the cervical epidural injection revealed no residual hemorrhage or edema. Discussion Neurological complications associated with RFA have rarely been reported in the literature. A single case of L5 root injury, kyphosis/dropped head syndrome after multilevel cervical lesioning, transient tetraplegia, hoarseness, spinal accessory nerve injury, and Horner’s syndrome has been documented. 9 , 17 , 22–26 Ahmed

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Atsushi Umemura, Yuichi Oka, Kenji Ohkita, Takemori Yamawaki, and Kazuo Yamada

, 2003 16 Suzuki M , Hirai T , Ito Y , Sakamoto T , Oka H , Kurita A , : Pramipexole-induced antecollis in Parkinson's disease . J Neurol Sci 264 : 195 – 197 , 2008 17 Taguchi Y , Takashima S , Tanaka K : Pramipexole-induced dropped head syndrome in Parkinson's disease . Intern Med 47 : 2011 – 2012 , 2008 18 Villarejo A , Camacho A , García-Ramos R , Moreno T , Penas M , Juntas R , : Cholinergic-dopaminergic imbalance in Pisa syndrome . Clin Neuropharmacol 26 : 119 – 121 , 2003 19 Yamada K , Goto S

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Cheerag D. Upadhyaya, Philip A. Starr, and Praveen V. Mummaneni

paraspinal muscles and histopathological features consistent with myositis. The patient was treated with steroids and they noted marked improvement in forward flexion. Myopathy with nemaline rods, end-stage myopathy with autophagic vacuoles, mitochondrial myopathy, and necrotizing myopathy have all been associated with camptocormia in patients with PD. 15 , 25 , 30 Gydnia et al. 15 have studied 19 consecutive muscle biopsies obtained in patients with PD and either camptocormia or dropped-head syndrome (anterocollis), finding abnormal muscle biopsies in all patients

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Christopher P. Ames, Justin S. Smith, Justin K. Scheer, Christopher I. Shaffrey, Virginie Lafage, Vedat Deviren, Bertrand Moal, Themistocles Protopsaltis, Praveen V. Mummaneni, Gregory M. Mundis Jr., Richard Hostin, Eric Klineberg, Douglas C. Burton, Robert Hart, Shay Bess, Frank J. Schwab, and the International Spine Study Group

SL : Surgical treatment of fixed cervical kyphosis with myelopathy . Spine (Phila Pa 1976) 33 : 771 – 778 , 2008 41 Petheram TG , Hourigan PG , Emran IM , Weatherley CR : Dropped head syndrome: a case series and literature review . Spine (Phila Pa 1976) 33 : 47 – 51 , 2008 42 Poulter GT , Garton HJ , Blakemore LC , Hensinger RN , Graziano GP , Farley FA : Mortality and morbidity associated with correction of severe cervical hyperextension . Spine (Phila Pa 1976) 34 : 378 – 383 , 2009 43 Samudrala S , Vaynman S