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European Spine Journal

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01-08-2018 | Grand Rounds

Correction of dropped head deformity through combined anterior and posterior osteotomies to restore horizontal gaze and improve sagittal alignment

Authors: Wesley H. Bronson, Michael J. Moses, Themistocles S. Protopsaltis

Published in: European Spine Journal | Issue 8/2018

Abstract

Objective

The aim of this study is to present our technique for a large focal correction of a partially flexible dropped head deformity through combined anterior and posterior osteotomies, as well as anterior soft tissue releases.

Methods

One patient with dropped head deformity underwent an anterior and posterior osteotomy with anterior soft tissue release.

Results

The patient recovered well, with postoperative radiographs demonstrating significant improvement in coronal and sagittal alignment. His C2–C7 sagittal vertical axis improved from 7.5 cm preoperatively to less than 4 cm postoperatively and his C2–C7 sagittal Cobb improved from 35° of kyphosis to 10° of lordosis.

Conclusion

In this report, we present our technique for a large focal correction of a partially flexible dropped head deformity through combined anterior and posterior osteotomies and anterior soft tissue releases. These more conservative osteotomies permitted gradual deformity correction and alleviated the need for pedicle subtraction osteotomy. We were able to restore horizontal gaze and improve sagittal malalignment. Although the technique we present here is one of many possible options for managing the deformity, we believe this combined approach is safe and effective and well tolerated by patients.

Suarez GA, Kelly JJ Jr (1992) The dropped head syndrome. Neurology 42:1625–1627CrossRefPubMed

Hoffman D, Gutmann L (1994) The dropped head syndrome with chronic inflammatory demyelinating polyneuropathy. Muscle Nerve 17:808–810CrossRefPubMed

Yoshiyama Y, Takama J, Hattori T (1999) The dropped head sign in parkinsonism. J Neurol Sci 167:22–25CrossRefPubMed

Katz JS, Wolfe GI, Burns DK et al (1996) Isolated neck extensor myopathy: a common cause of dropped head syndrome. Neurology 46:917–921CrossRefPubMed

Ueda T, Kanda F, Kobessho H et al (2009) “Dropped head syndrome” caused by Lambert–Eaton myasthenic syndrome. Muscle Nerve 40(1):134–136CrossRefPubMed

Sharan AD, Kaye D, Malveaux W et al (2012) Dropped head syndrome: etiology and management. J Am Acad Orthop Surg 20(12):766–774PubMed

Gerling MC, Bohlman HH (2008) Dropped head deformity due to cervical myopathy: Surgical treatment outcomes and complications spanning twenty years. Spine (Phila Pa 1976) 33(20):E739–E745CrossRef

Smith JS, Klineberg E, Shaffrey CI, et al. Assessment of surgical treatment strategies for moderate to severe cervical spinal deformity reveals marked variation in approaches, osteotomies and fusion levels. World Neurosurg. 2016 pii: S1878-8750(16)30093-6 (Epub ahead of print)

Theologis AA, Tabaraee E, Funao H, Smith JS, Burch S, Tay B, Kebaish K, Deviren V, Ames C (2015) Three-column osteotomies of the lower cervical and upper thoracic spine: comparison of early outcomes, radiographic parameters, and perioperative complications in 48 patients. Eur Spine J 24(Suppl 1):S23–S30PubMed

10.

Kim HJ, Piyaskulkaew C, Riew KD (2015) Comparison of Smith-Petersen osteotomy versus pedicle subtraction osteotomy versus anterior–posterior osteotomy types for the correction of cervical spine deformities. Spine 40(3):143–146CrossRefPubMed

11.

Protopsaltis T, Bronsard N, Soroceanu A, Henry JK, Lafage R, Smith J, Klineberg E, Mundis G, Kim HJ, Hostin R, Hart R, Shaffrey C, Bess S, Ames C (2017) Cervical sagittal deformity develops after PJK in adult thoracolumbar deformity correction: radiographic analysis utilizing a novel global sagittal angular parameter, the CTPA. Eur Spine J 26(4):1111–1120. doi:10.1007/s00586-016-4653-7 CrossRefPubMed

12.

Yang M, Yang C, Ni H, Zhao Y, Li M (2016) The relationship between T1 sagittal angle and sagittal balance: a retrospective study of 119 healthy volunteers. PLoS One 11(8):e0160957. doi:10.1371/journal.pone.0160957 CrossRefPubMedPubMedCentral

13.

Ames CP, Smith JS, Shaffrey CI et al (2013) A standardized nomenclature for cervical spine soft-tissue release and osteotomy for deformity correction: clinical article. J Neurosurg Spine 19(3):269–278CrossRefPubMed

14.

Schwab F, Blondel B, Chay E (2015) The comprehensive anatomical spinal osteotomy classification. Neurosurgery 76(Suppl 1):S33–S41CrossRefPubMed

15.

Le Huec JC, Demezon H, Aunoble S (2015) Sagittal parameters of global cervical balance using EOS imaging: normative values from a prospective cohort of asymptomatic volunteers. Eur Spine J 24(1):63–71CrossRefPubMed

Title: Correction of dropped head deformity through combined anterior and posterior osteotomies to restore horizontal gaze and improve sagittal alignment
Authors: Wesley H. Bronson
Michael J. Moses
Themistocles S. Protopsaltis
Publication date: 01-08-2018
Publisher: Springer Berlin Heidelberg
Published in: European Spine Journal / Issue 8/2018
Print ISSN: 0940-6719
Electronic ISSN: 1432-0932
DOI: https://doi.org/10.1007/s00586-017-5184-6

Keynote webinar | Spotlight on medication adherence

Springer Medicine

Correction of dropped head deformity through combined anterior and posterior osteotomies to restore horizontal gaze and improve sagittal alignment

Abstract

Objective

Methods

Results

Conclusion

Keynote webinar | Spotlight on medication adherence

Springer Medicine

Abstract

Objective

Methods

Results

Conclusion

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