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Open Access 01-12-2021 | Research

Histopathological characteristics of cervical extensor tissue in patients with dropped head syndrome

Authors: Kenji Endo, Jun Matsubayashi, Yasunobu Sawaji, Kazuma Murata, Takamitsu Konishi, Toshitaka Nagao, Kengo Yamamoto

Published in: European Journal of Medical Research | Issue 1/2021

Abstract

Background

To date, the histopathologic characteristics of dropped head syndrome (DHS) have not been reported sufficiently. The present study investigates the histopathology of biopsy specimens from the cervical paravertebral region in patients with DHS.

Methods

Histopathological parameters were evaluated in biopsy specimens of the cervical paravertebral soft tissue from 15 patients with DHS.

Results

Among the 15 cases of DHS examined, skeletal muscle was identified in 7 cases, all of which showed necrosis, microvessel proliferation and atrophy. The ligament was identified in 12 cases, 8 of which showed degeneration. The lag time between the onset of symptoms and the performance of a biopsy in all 8 cases, which showed degeneration was over 3 months. Microvessel proliferation in the ligament was observed in 1 of the 4 cases, in which the lag time between the onset of symptoms and the performance of a biopsy was less than 3 months (acute or subacute phase), and in 7 of the 8 cases, in which the lag time between the symptoms and the performance of a biopsy was over 3 months (chronic phase). Chronic inflammation in the ligament was identified in 1 of the 12 cases.

Conclusions

The identification of necrosis, microvessel proliferation, and atrophy in the skeletal muscle of patients with DHS and the presence of ligament degeneration and microvessel proliferation in the chronic but not acute or subacute phases may suggest that persistent skeletal muscle damage of the cervical paravertebral region causes subsequent ligament damage in patients with DHS.

Katz J, Wolfe G, Burns D, Bryan W, Fleckenstein J, Barohn RJN. Isolated neck extensor myopathy: a common cause of dropped head syndrome. Neurology. 1996;46(4):917–21. https://doi.org/10.1212/wnl.46.4.917.CrossRefPubMed

Kastrup A, Gdynia H-J, Nägele T, Riecker A. Dropped-head syndrome due to steroid responsive focal myositis: a case report and review of the literature. J Neurol Sci. 2008;267(1–2):162–5. https://doi.org/10.1016/j.jns.2007.09.042.CrossRefPubMed

Sharan AD, Kaye D, Charles Malveaux WM, Riew KD. Dropped head syndrome: etiology and management. J Am Acad Orthop Surg. 2012;20(12):766–74. https://doi.org/10.5435/JAAOS-20-12-766.CrossRefPubMed

Petheram TG, Hourigan PG, Emran IM, Weatherley CR. Dropped head syndrome: a case series and literature review. Spine. 2008;33(1):47–51. https://doi.org/10.1097/BRS.0b013e31815e38ec.CrossRefPubMed

Suarez GA, Kelly JJ. The dropped head syndrome. Neurology. 1992;42(8):1625–7. https://doi.org/10.1212/wnl.42.8.1625.CrossRefPubMed

Endo K, Kudo Y, Suzuki H, Aihara T, Matsuoka Y, Murata K, Takamatsu T, Sawaji Y, Nishimura H, Matsuoka A, Ishikawa K, Maruyama H, Fukutake K, Wada A, Takahashi H, Toyone T, Yamamoto K. Overview of dropped head syndrome (Combined survey report of three facilities). J Orthop Sci. 2019;24(6):1033–6. https://doi.org/10.1016/j.jos.2019.07.009.CrossRefPubMed

Jaster JH, Bertorini TE, Swims MP, Dohan FC, Menke PG, Becske T, Mönkemüller KE. Cervical kyphosis after resolution of myopathic head drop: a case report. Spine. 1996;21(17):2023–5. https://doi.org/10.1097/00007632-199609010-00020.CrossRefPubMed

Murata K, Kenji E, Suzuki H, Takamatsu T, Nishimura H, Matsuoka Y, Sawaji Y, Tanaka H, Yamamoto K. Spinal sagittal alignment in patients with dropped head syndrome. Spine. 2018;43(21):E1267–73. https://doi.org/10.1097/BRS.0000000000002685.CrossRefPubMed

Eguchi Y, Toyoguchi T, Koda M, Suzuki M, Yamanaka H, Tamai H, Kobayashi T, Orita S, Yamauchi K, Suzuki M. The influence of sarcopenia in dropped head syndrome in older women. Scoliosis Spinal Disord. 2017;12:5. https://doi.org/10.1186/s13013-017-0110-6.CrossRefPubMedPubMedCentral

10.

Grant’s Atlas of Anatomy (10th edn.). Lippincott Williams and Wilkins, Philadelphia; 1999. 271–82.

Title: Histopathological characteristics of cervical extensor tissue in patients with dropped head syndrome
Authors: Kenji Endo
Jun Matsubayashi
Yasunobu Sawaji
Kazuma Murata
Takamitsu Konishi
Toshitaka Nagao
Kengo Yamamoto
Publication date: 01-12-2021
Publisher: BioMed Central
Published in: European Journal of Medical Research / Issue 1/2021
Electronic ISSN: 2047-783X
DOI: https://doi.org/10.1186/s40001-021-00605-8

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Springer Medicine

Histopathological characteristics of cervical extensor tissue in patients with dropped head syndrome

Abstract

Background

Methods

Results

Conclusions

Keynote webinar | Spotlight on medication adherence

Springer Medicine

Abstract

Background

Methods

Results

Conclusions

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