Isolated neck extensor myopathy causing a dropped head: a case report.

Area of Science:

• Neurology
• Orthopedic Surgery
• Spinal Medicine

Background:

• Isolated neck extensor myopathy is a rare condition characterized by weakness in the muscles responsible for neck extension.
• This can lead to a "dropped head" deformity and significant functional impairment.
• Progressive cervical spine destruction and myelopathy can occur due to chronic mechanical stress.

Observation:

• A 71-year-old woman presented with a dropped head and difficulty extending her neck, diagnosed as isolated neck extensor myopathy.
• Initial conservative treatment with a cervical collar and physical therapy provided only temporary symptom relief.
• Cervical vertebral destruction and myelopathy worsened due to repeated microfractures from mechanical stress.

Findings:

• The patient underwent a two-stage surgical procedure involving combined anterior and posterior decompression and fusion with autografts.
• One-year follow-up demonstrated complete resolution of bilateral upper limb numbness.
• Radiographic evidence confirmed successful bone union, and the patient achieved the ability to look forward, reporting high satisfaction.

Implications:

• Surgical intervention is a viable option for managing advanced cases of isolated neck extensor myopathy with cervical instability and myelopathy.
• Combined anterior-posterior decompression and fusion can effectively stabilize the cervical spine and decompress neural elements.
• Restoration of cervical alignment and neurological function can significantly improve quality of life in patients with this debilitating condition.