Dropped head syndrome: report of a rare complication after multilevel bilateral cervical radiofrequency neurotomy

Bajaj, Harnek S.; Chapman, Andrew W.

doi:10.1097/pr9.0000000000001037

Cited by 4 publications

(8 citation statements)

References 20 publications

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“…The same findings were confirmed in a subsequent study by Smuck et al. [ 44 ], and a significant loss of paravertebral muscles, requiring stabilization, was observed after cervical MB radiofrequency denervation [ 45 ]. On the contrary, recently published articles did not confirm these findings [ 46 ].…”

Section: Discussionsupporting

confidence: 72%

“…An adequate rehabilitation program should be implemented after LRFN since it improves the neuromuscular control, the endurance, and the strength of many muscles involved in maintenance of dynamic spinal stability [ 45 ]. Almost all the panelists considered the importance of rehabilitation programs after LRFN (statement 14: 95% first round agreement).…”

Section: Discussionmentioning

confidence: 99%

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Delphi-Based Expert Consensus Statements for the Management of Percutaneous Radiofrequency Neurotomy in the Treatment of Lumbar Facet Joint Syndrome

Occhigrossi¹,

Carpenedo²,

Leoni³

et al. 2023

Pain Ther

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Introduction A modified Delphi strategy was implemented for obtaining recommendations that could be useful in the management of percutaneous radiofrequency treatment of lumbar facet joint syndrome, as the literature on the argument was poor in quality. Methods An Italian research team conducted a comprehensive literature search, defined the investigation topics (diagnosis, treatment, and outcome evaluation), and developed an explorative semi-structured questionnaire. They also selected the members of the panel. After an online meeting with the participants, the board developed a structured questionnaire of 15 closed statements (round 1). A five-point Likert scale was used and the cut-off for consensus was established at a minimum of 70% of the number of respondents (level of agreement ≥ 4, agree or strongly agree). The statements without consensus were rephrased (round 2). Results Forty-one clinicians were included in the panel and responded in both rounds. After the first round, consensus (≥ 70%) was obtained in 9 out of 15 statements. In the second round, only one out of six statements reached the threshold. The lack of consensus was observed for statements concerning the use of imaging for a diagnosis [54%, median 4, interquartile range (IQR) 3–5], number of diagnostic blocks (37%, median 4, IQR 2–4), bilateral denervation (59%, median 4, IQR 2–4), technique and number of lesions (66%, median 4, IQR 3–5), and strategy after denervation failure (68%, median 4, IQR 3–4). Conclusion Results of the Delphi investigations suggest that there is a need to define standardized protocols to address this clinical problem. This step is essential for designing high-quality studies and filling current gaps in scientific evidence. Supplementary Information The online version contains supplementary material available at 10.1007/s40122-023-00512-2.

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Section: Discussionsupporting

confidence: 72%

Section: Discussionmentioning

confidence: 99%

Delphi-Based Expert Consensus Statements for the Management of Percutaneous Radiofrequency Neurotomy in the Treatment of Lumbar Facet Joint Syndrome

Occhigrossi¹,

Carpenedo²,

Leoni³

et al. 2023

Pain Ther

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“…При непрерывной РЧД происходит тепловое повреждение целевого нерва и окружающих структур. Преходящая постпроцедурная боль и дизестезия -это часто регистрируемые осложнения, которые обычно не требуют дополнительных вмешательств и исчезают самостоятельно [30]. В отличие от непрерывной РЧД импульсная более безопасна, так как при ней температура в окружающих нерв тканях не превышает 42°C, что предотвращает их необратимое повреждение.…”

Section: рчд (аблация) медиальной ветвиunclassified

Non-pharmacological methods of treating chronic non-specific neck pain, possibilities of radiofrequency denervation: A review

Gaydash,

Akif,

Zonov

2024

Consilium Medicum

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Chronic non-specific neck pain (CNSNP), or cervicodynia, is a common pathology that significantly reduces the quality of life of patients. It is believed to be based on degenerative and dystrophic changes in the spine, as well as myofascial pain syndrome. Currently, a comprehensive approach is used in the treatment of CNSNP, including kinesitherapy, ergotherapy, manual therapy, and cognitive-behavioral therapy. In case of ineffectiveness of conservative patient management methods, radiofrequency denervation is used, which is an effective and safe procedure for reducing the severity of pain syndrome. The results of the use of radiofrequency denervation in CNSNP are discussed.

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“…A positive response to multiple medial branch blocks (MBBs) is typically required prior to undergoing RFA [6,7]. Reported complications from MBBs are rare when following proper procedural protocol [8,9]. Dropped head syndrome (DHS) is characterized by profound muscle weakness in the cervical spine, resulting in a failure to maintain a level horizontal gaze and, in the worst cases, a chin-on-chest deformity.…”

Section: Introductionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

The Occurrence of Dropped Head Syndrome After a Cervical Medial Branch Nerve Block in a Patient With Cervicothoracic Kyphotic Deformity: A Case Report

Adeniran,

Courtois,

Ohnmeiss

2024

Cureus

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Complications from medial branch blocks (MBBs) are rare when following proper procedural protocol. Dropped head syndrome (DHS) is characterized by profound muscle weakness in the cervical spine, resulting in a failure to maintain a level horizontal gaze and, in the worst cases, a chin-on-chest deformity. In this case report, we described DHS developing after cervical MBBs using short-acting anesthetic agents and subsequent management. A 69-year-old woman with a previous C6-C7 anterior cervical discectomy and fusion (ACDF) underwent bilateral posterior cervical MBBs targeting the C4-C5 and C5-C6 levels. Immediately following the injection, she reported a sudden inability to lift her head and was subsequently diagnosed with DHS. This condition continued with minimal improvement for over six months. After weighing the risks, the patient elected to avoid surgery, and she was provided a soft cervical collar and prescribed physical therapy. DHS is a debilitating condition more commonly associated with neurodegenerative conditions and inflammatory myopathy, which has received limited attention due to its rarity as a complication of cervical radiofrequency neurotomy. Surgery for this condition, when considered, typically involves long-segment posterior cervical instrumented fusion. Undergoing such a surgery is a complicated discussion that should consider patient clinical factors and preferences. The clinical impact of loss of strength in paraspinal musculature in this patient population is clearly deserving of further study.

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Dropped head syndrome: report of a rare complication after multilevel bilateral cervical radiofrequency neurotomy

Abstract: Dropped head syndrome is a rarely discussed complication of cervical radiofrequency neurotomy. Here, we review presentation, management, and possible mitigating factors of this complication.

Cited by 4 publications

References 20 publications

Delphi-Based Expert Consensus Statements for the Management of Percutaneous Radiofrequency Neurotomy in the Treatment of Lumbar Facet Joint Syndrome

Delphi-Based Expert Consensus Statements for the Management of Percutaneous Radiofrequency Neurotomy in the Treatment of Lumbar Facet Joint Syndrome

Non-pharmacological methods of treating chronic non-specific neck pain, possibilities of radiofrequency denervation: A review

The Occurrence of Dropped Head Syndrome After a Cervical Medial Branch Nerve Block in a Patient With Cervicothoracic Kyphotic Deformity: A Case Report

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