Dropped Head Syndrome

Petheram, Timothy; Hourigan, Patrick; Emran, Ihab; Weatherley, CR

doi:10.1097/brs.0b013e31815e38ec

Cited by 80 publications

(32 citation statements)

References 22 publications

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“…A prior case series of seven patients with DHS of various etiologies, excluding radiation treatment as in the present study, detailed the outcomes of seven patients treated conservatively with a cervical collar in conjunction with physical therapy. 10 Of those seven patients, three showed improvement in their ability to temporarily extend the neck in an effort-dependent manner. Unlike the previous case study, one of the limitations of the present study is the absence of an objective outcome measure.…”

Section: Discussionmentioning

confidence: 94%

The Role of the Headmaster Collar (Cervical) for Dropped Head Syndrome in Hodgkin Lymphoma Survivors

Kim

Stubblefield

2019

PM&R

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Background Dropped head syndrome is a potential late neurologic complication of radiation therapy in survivors of Hodgkin lymphoma. There is limited evidence for conservative management of this condition. Objective To discover patient utilization patterns of the commonly prescribed Headmaster Collar (cervical) in Hodgkin lymphoma survivors with radiation‐induced dropped head syndrome. Design Questionnaire‐based retrospective observational study. Setting Single‐site academic cancer center. Patients Twenty‐six Hodgkin lymphoma survivors treated with radiation therapy involving the mantle who were prescribed a Headmaster Collar for dropped head syndrome. Methods or Interventions Patients were interviewed by phone with a structured set of questions. Main Outcome Measurements Compliance, patterns of use, individual modifications, and side effects of collar use. Results Although 58% of patients who were prescribed a Headmaster Collar eventually discontinued its use, 62% of all patients used the collar for more than 6 months. The majority of users wore the collar for up to 3 hours per day, usually for static seated activities. Thirty‐eight percent of patients made personal modifications to their collar, most commonly the addition of extra padding. All but one patient had complaints about the collar, most commonly discomfort, rigidity, and confinement. Conclusions The Headmaster Collar (cervical) is often utilized for a few hours a day, for longer than 6 months, to help with static seated activities. Insights from this study might help to improve future orthotic designs with better long‐term compliance rates for the treatment of radiation‐induced dropped head syndrome. Level of Evidence IV

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Section: Discussionmentioning

confidence: 94%

The Role of the Headmaster Collar (Cervical) for Dropped Head Syndrome in Hodgkin Lymphoma Survivors

Kim

Stubblefield

2019

PM&R

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“…Conservative treatment is considered, in the patients with serious comorbidities, but is limited to strengthening exercises and wearing collars. Cervical collars, despite their ability to maintain the head in an upright position, are frequently not tolerated well by the patient, and they may lead to a pressure sores under the chin and on the occiput [ 2 , 3 , 13 ].…”

Section: Discussionmentioning

confidence: 99%

“…To achieve these goals, an appropriate surgery can be performed with either a circumferential or posterior only approach. In fact, both combined anterior-posterior and posterior only decompression and stabilization have been advocated [ 2 , 3 , 15 , 16 ].…”

Section: Discussionmentioning

confidence: 99%

“…However, as it was clearly demonstrated in the current case, this formulation did not work and despite the plumb line falling posterior to manubrium, C2 to C7 instrumentation was insufficient and our construction failed. Therefore, it seems that it is better to extend the construct to the upper thoracic spine in all the patients who suffer from dropped head syndrome in isolation or as a combined pathology [ 2 , 3 , 14 , 17 – 19 ], in particular with consideration of the natural course of INEM which might be the progression of isolated myopathy to the muscles of the upper thoracic spine with time [ 18 ].…”

Section: Discussionmentioning

confidence: 99%

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Cervical Spondylotic Myelopathy Secondary to Dropped Head Syndrome: Report of a Case and Review of the Literature

Rahimizadeh

Soufiani

Rahimizadeh

2016

Case Reports in Orthopedics

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The dropped head syndrome (DHS) is a disabling condition caused by severe weakness of the neck extensor muscles causing progressive reducible kyphosis of the cervical spine and the inability to hold the head up. Weakness can occur in isolation or in association with a generalized neuromuscular disorder. Isolated cases are owed to the late onset of noninflammatory myopathy designated as INEM, where persistent chin to chest deformity may gradually cause or aggravate preexisting degenerative changes of the cervical spine and ultimately result in myelopathy. In review of the literature, we could find only 5 cases, with no unique guidelines to address the management of these two concomitant pathologies. Herein, a 69-year-old man who had developed cervical myelopathy 2 years after being affected by isolated dropped head syndrome is presented. Chin to chest deformity and cervical myelopathy were managed through three-level anterior cervical discectomy and fusion (ACDF) combined with decompressive cervical laminectomy and stabilization with C2 to C7 pedicle screw-rod construct. At 4-month follow-up, despite recovery in patient's neurological status, flexion deformity reappeared with recurrence of dropped head due to C7 pedicle screws pull-out. However, this was successfully managed with extension of the construct to the upper thoracic levels.

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“…One case of failure after surgical treatment with posterior correction and fusion without anterior reconstruction has been reported [9]. The authors mentioned the risk of implant pullout and failure to achieve adequate fixation of instrumentation in elderly patients due to osteoporosis.…”

Section: Discussionmentioning

confidence: 99%

Dropped head syndrome due to myogenic atrophy --- a case report of surgical treatment

et al. 2011

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We report a case of a 69-year-old man with dropped head syndrome associated with isolated neck extensor myopathy (INEM). Over a period of 2 years, he exhibited progressive inability to lift his chin off his chest, resulting in the dropped head position that impaired his activities of daily living. He had a disturbed gait with severe imbalance of spinal alignment. Computed tomography revealed osseous contracture of cervical vertebral bodies in flexed position. Anterior combined posterior reconstruction surgery yielded a successful outcome in his activities of daily living, including his walking balance of spinal alignment. Pathologic study confirmed myogenic atrophy in the cervical extensor muscles. We suggest that consideration for surgical management should be given to dropped head syndrome especially due to INEM.

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Dropped Head Syndrome

Abstract: We conclude that the option of surgical management must be carefully considered in each case, especially with respect to the potential disadvantages in elderly patients.

Cited by 80 publications

References 22 publications

The Role of the Headmaster Collar (Cervical) for Dropped Head Syndrome in Hodgkin Lymphoma Survivors

The Role of the Headmaster Collar (Cervical) for Dropped Head Syndrome in Hodgkin Lymphoma Survivors

Cervical Spondylotic Myelopathy Secondary to Dropped Head Syndrome: Report of a Case and Review of the Literature

Dropped head syndrome due to myogenic atrophy --- a case report of surgical treatment

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