Dropped head syndrome (DHS) is a relatively rare condition, with a broad differential diagnosis. This deformity has significant implications on the health and quality of life of affected individuals. While surgery seems to be an obvious therapeutic option, there is a paucity of information on surgical intervention with no clear consensus on an optimal approach or timing.We present a case of DHS in a young woman to illustrate this condition, and review the current literature. Although at present the only definitive solution for correction and stabilization of DHS is surgical intervention involving multilevel instrumented fixation and fusion, this condition requires a persistent medical workup and treatment of reversible causes before surgical intervention is contemplated.

We report a novel approach in the treatment of spinal metastases with epidural disease and mechanical instability using a combined minimal access spine surgery (MASS) technique followed by spine stereotactic body radiotherapy (SBRT). This study was performed as a retrospective review of the first ten consecutive patients treated with this combined approach.The MASS technique was based on a tubular retraction system to gain access for decom pression and mechanical stabilization achieved using methylmethacrylate (MMA) applied under direct visualization. SBRT consisted of one to five image-guided high dose per fraction treatments. Eight patients were symptomatic at baseline. Pain, disability, and quality of life (QOL) were prospectively determined using the visual analogue score (VAS), Oswestry Disability Index (ODI), and ShortForm36 version 2, respectively. The median followup was 13 months (range, 318). MASS successfully decompressed each patient. The median blood loss was 335 ml. Following MASS, the median time to SBRT treatment planning was 6.5 days and subsequent median time to treatment was 7 days. Local control was observed in 7 of the 10 patients. Improvements in VAS, ODI and QOL were observed postSBRT. We report preliminary efficacy for our MASS-SBRT combined approach for patients with spinal metastases, mechanical pain and epidural disease.

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