Surgical treatment for dropped head syndrome with cervical spondylotic amyotrophy: a case report

Spinal surgery for a late-onset axial myopathy

Axial myopathies with paraspinal predominance usually present with dropped head, abnormal posture or rigidity of the spine. Management of axial myopathy can be difficult and there is little data in the literature about surgical treatment. We discuss a case of axial myopathy with late-onset scoliosis and dropped head, focusing on the surgical management of the case.

Dropped Head Syndrome Treated with Physical Therapy Based on the Concept of Athletic Rehabilitation

Patients with dropped head syndrome (DHS) show severe cervical kyphosis, i.e., chin-on-chest deformity, and their activities of daily living are impaired considerably. However, the therapeutics for DHS, especially conservative treatment, have not been fully established. A 75-year-old woman suffered from DHS, which she developed from neck pain due to cervical spondylosis. Examinations showed atrophy and dysfunction of her cervical extensor muscles. For this patient, we created a special program of physical therapy based on the concept of athletic rehabilitation and provided her the athletic rehabilitation-based physical therapy (AR-PT). After starting AR-PT, the patient's neck pain was relieved. She recovered from DHS, and the atrophy of her cervical extensor muscles improved. This study suggests that our program of AR-PT improves cervical extensor muscle insufficiency in patients with DHS and corrects their cervical kyphosis.

Cervical Spondylotic Amyotrophy: Case Series and Review of the Literature

OBJECTIVE

Cervical spondylotic amyotrophy (CSA) is a relatively rare entity caused by cervical degenerative spinal diseases and characterized by motor weakness accompanied by remarkable muscle atrophy in the upper extremities without significant sensory deficits or spastic paraparesis in the lower extremities. Postoperative outcomes and predictive prognostic factors vary among previous reports. In the present report, we describe the surgical results in patients who were surgically treated for CSA and present a literature review.

METHODS

In total, 33 patients with CSA were retrospectively analyzed. Correlations between the surgical outcome and the following factors were statistically analyzed: age, sex, type of impaired muscle, preoperative severity of motor weakness, number of levels of cord or root compression, presence of a T2 high-intensity area in the spinal cord, cervical kyphosis, and methods of surgical procedure.

RESULTS

On postoperative neurological evaluation, 25 patients (75.8%) had favorable outcomes and 8 had unfavorable outcomes (proximal type, 72.2%; distal type, 78.6%). Patients with favorable outcomes were significantly younger than those with unfavorable outcomes (p=0.013). Patient's characteristics except for age and radiological factors were not correlated to surgical outcome.

CONCLUSION

The present study focused on the surgical results in patients who were surgically treated for CSA along with updated information from a literature review. Improvement of motor weakness is expected with acceptable prevalence although higher age can be a negative factor. Surgical outcomes and predictive factors related to a poor prognosis were determined and compared with those of previous articles.