Surgical management of dropped head syndrome: A systematic review.

Background: Dropped head syndrome (DHS) is uncommon and involves severe weakness of neck-extensor muscles resulting in a progressive reducible cervical kyphosis. The first-line management consists of medical treatment targeted at diagnosing underlying pathologies. However, the surgical management of DHS has not been well studied.

Methods: Here, we systematically reviewed the PubMed and Cochrane databases for DHS using the Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines. All relevant articles up to March 31, 2022, were analyzed. The patient had to be ≥18 years with DHS and had to have undergone surgery with outcomes data available. Outcomes measurements included neurological status, rate of failure (RF), horizontal gaze, and complications.

Results: A total of 22 articles selected for this study identified 54 patients who averaged 68.9 years of age. Cervical arthrodesis without thoracic extension was performed in seven patients with a RF of 71%. Cervicothoracic arthrodesis was performed in 46 patients with an RF of 13%. The most chosen upper level of fusion was C2 in 63% of cases, and the occiput was included only in 13% of patients. All patients neurologically stabilized or improved, while 75% of undergoing anterior procedures exhibited postoperative dysphagia and/or airway-related complications.

Conclusion: The early surgery for patients with DHS who demonstrate neurological compromise or progressive deformity is safe and effective and leads to excellent outcomes.