Lessons From Recurrent Dropped Head Syndrome After Inadequate Short Fixation: A Case Series

Area of Science:

• Neurology
• Orthopedic Surgery
• Geriatrics

Background:

• Dropped head syndrome (DHS) involves forward head posture due to cervical extensor muscle weakness.
• It significantly impacts horizontal gaze and activities of daily living (ADL), particularly in elderly women.
• Surgical intervention is considered for refractory cases, but standardized procedures remain unclear.

Observation:

• A retrospective analysis of five elderly female patients with DHS who underwent surgical correction.
• Initial treatments with short-segment fixation or laminoplasty failed in three patients, necessitating revision.
• All patients ultimately required long-segment fixation, extending from C2/occiput to Th1/Th2.

Findings:

• Surgical correction restored cervical lordosis and improved sagittal imbalance (SVA, T1 slope).
• Four patients achieved sustained horizontal gaze (>30 minutes) and improved ADL.
• One patient experienced a fatal outcome from aspiration pneumonia despite successful gaze restoration.

Implications:

• Long-segment corrective fixation is a viable and effective surgical strategy for dropped head syndrome.
• This approach can significantly improve functional outcomes and quality of life for affected individuals.
• Further research into standardized indications and techniques for surgical DHS correction is warranted.