Outcomes of Conservative Versus Surgical Treatment of Dropped Head Syndrome in a Single Institution: A Case Series and Review of the Literature

Dropped head syndrome (DHS), also known as camptocephalia, is characterized by a mobile chin-on-chest deformity from hypotonia of the cervical extensor muscle or hypertonia of the anterior neck muscles. There remains a paucity of quality published literature on this topic, particularly its management. The objective of this study is to identify radiographic and clinical outcomes of surgery as compared to nonsurgical treatment, to summarize the literature, and to create a decision-making paradigm for managing patients with DHS. As such, we report outcomes of our retrospective chart review series as well as a literature review on the etiology, management options, and outcomes. In our series, we examined the radiographic parameters of the C2-C7 Cobb angle, C2-C7 sagittal vertical axis (SVA), and T1 slope, as well as clinically reported outcomes of conservatively managed (CM; N = 8) and surgically managed (SM; N = 5) interventions on 13 patients with DHS at a single institution. At initial presentation, the CM group had poorer C2-C7 Cobb angle (-37.8 ± 3.2 degrees) and C2-C7 SVA (77.1 ± 10.6 mm) in comparison to the SM group (-21.0 ± 30.3 degrees and 56.9 ± 16.2 mm, respectively). We found a statistically significant improvement in the C2-C7 Cobb angle and T1 slope (p-value of 0.024 and 0.019, respectively) after surgery. Clinically, only one patient in the CM group (20%) reported improvement versus six patients in the SM group (80%). Our study is limited by its small sample size, albeit it is the largest cohort of patients treated at a single institution in the United States to our knowledge. Although our cohort was comprised of heterogeneous etiologies and patient comorbidities, we found that surgery can be beneficial in the right patient. To aid in proper surgical selection, we provide an algorithm for workup and management of DHS.