Dropped head syndrome - A case series and literature review

Study Design. Case series and literature review. Objective. To describe Dropped Head Syndrome (DHS) to the orthopedic community and examine the management of this condition including the role of surgery. Summary of Background Data. DHS is characterized by severe neck extensor weakness, resulting in chin-on-chest deformity in the standing or sitting position, which is correctable by passive neck extension. The syndrome is familiar to neurologists but is little known in the orthopedic community and literature. DHS patients may present to the spinal surgeon to consider surgical management. Methods. We summarize the case histories of 7 patients who presented to the Exeter Spinal Unit with this disabling condition. Investigation, management, and the few publications on surgical management of DHS are discussed. One of the patients in our series underwent surgical management, and we discuss the possibilities for surgical management, along with the outcome of surgery in this case. Results. Seven cases of DHS presented to our unit, 4 with acute presentation and 3 with gradual onset. Six patients were treated conservatively. One patient was treated surgically but was unhappy with the outcome. Conclusion. 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.