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

Dropped head syndrome (DHS) is a condition in which the head falls forward due to dysfunction or atrophy of the cervical extensor muscles. It is more commonly observed in elderly women and significantly affects horizontal gaze and activities of daily living (ADL). For cases in which conservative treatment is ineffective, surgical corrective fixation is considered; however, indications and standardized procedures have not yet been fully established. We retrospectively analyzed five cases of DHS treated surgically at our institution and examined the efficacy of corrective fixation and potential treatment strategies. Five patients (mean age: 82.6 years; all female) who underwent surgery for DHS between 2018 and 2024 were included. Three patients initially underwent short-segment fixation or laminoplasty, but DHS recurred. Eventually, all cases required long-segment fixation extending from C2 or the occiput to Th1/Th2. Radiological evaluations included measurements of the C2-C7 Cobb angles, sagittal vertical axis (SVA), and T1 slope before and after surgery. All patients exhibited cervical kyphosis and sagittal imbalance. Postoperatively, cervical lordosis was restored, and improvements were noted in SVA and T1 slope. In four cases, patients were able to maintain horizontal gaze for over 30 minutes, and improvements in ADL living were observed. One patient died from aspiration pneumonia, although horizontal gaze was maintained postoperatively. Long-segment corrective fixation within an appropriate range is considered a safe and effective treatment option.