• Thoracolumbar malalignment may contribute to dropped head syndrome. • Thoracolumbar correction improved symptoms without cervical fusion in two cases. • Cervical Electromyography showed postoperative reduction of spontaneous activity after realignment. Dropped head syndrome (DHS) is traditionally considered a cervical paraspinal muscle disorder, often associated with isolated neck extensor myopathy (INEM). However, emerging evidence suggests that thoracolumbar malalignment may contribute to its pathology. This study presents two DHS cases in which symptoms improved after thoracolumbar corrective surgery with cervical electromyography (EMG) changes, suggesting a possible secondary etiology related to global spinal malalignment. Two older adults with DHS and a history of thoracolumbar compression fractures presented with progressive neck pain and difficulty maintaining horizontal gaze. Neurological evaluation and EMG revealed myopathic changes in the cervical extensors without systemic neuromuscular disease. Conservative treatment, including physical therapy and cervical orthosis, was ineffective. Both patients underwent thoracolumbar surgery for spinal realignment. Postoperatively, symptoms improved significantly, and follow-up EMG showed reduced spontaneous activity of cervical extensor. These cases suggest that thoracolumbar malalignment may contribute to DHS and that symptom improvement can be observed after thoracolumbar corrective surgery without direct cervical intervention. The observed EMG changes following surgical correction indicate this dysfunction may be improved by addressing the underlying global spinal malalignment. These observations are hypothesis-generating and support careful assessment of global spinal alignment in DHS diagnosis and management.
Tani et al. (Sun,) studied this question.
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