Dropped head syndrome (DHS) is characterized by severe weakness of the cervical paraspinal muscles that results in the passively correctable chin-on-chest deformity. DHS is most commonly associated with neuromuscular disorders. However, it is not always accompanied by electromyographic findings or noticeable changes on muscle biopsy. In such cases, the term isolated neck extensory myopathy (INEM) is used instead. The literature on the management of INEM is limited. Most reports suggest that nonsurgical interventions help to stabilize the deformity. The literature on surgical management of INEM is limited and mixed, with outcomes ranging from poor to excellent. The prevalence of DHS likely will increase as life expectancy increases. Recent advances in our understanding of sagittal malalignment and surgical techniques have improved our ability to provide better quality of life for patients with cervical deformity.