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Radiological features of cervical spine in dropped head syndrome: a matched case–control study

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Abstract

Purpose

Dropped head syndrome (DHS) is presumably caused by focal myopathy in the cervical posterior muscles; however, distinguishable radiological features of the cervical spine in DHS remain unidentified. This study investigated the radiological features of the cervical spine in dropped head syndrome.

Methods

The records of DHS patients and age- and sex-matched cervical spondylotic myelopathy (CSM) patients were reviewed. Cervical spinal parameters (C2-7, C2-4, and C5-7 angles) were assessed on lateral cervical spine radiographs. Quantitative radiographic evaluation of cervical spine degeneration was performed using the cervical degenerative index (CDI), which consists of four elements: disk space narrowing (DSN), endplate sclerosis, osteophyte formation, and listhesis.

Results

Forty-one DHS patients were included. Statistically significant differences were noted between the upper and lower cervical spine in the sagittal angle parameters on the neutral, flexion, and extension radiographs in DHS group, whereas no significant differences were observed in CSM group. CDI comparison showed significantly higher scores of DSN in C3/4, C4/5, C5/6, and C6/7; sclerosis in C5/6 and C6/7; and osteophyte formation in C4/5, C5/6, and C6/7 in DHS group than in CSM group. Comparison of listhesis scores revealed significant differences in the upper levels of the cervical spine (C2/3, C3/4, and C4/5) between two groups.

Conclusion

Our results demonstrated that the characteristic radiological features in the cervical spine of DHS include lower-level dominant severe degenerative change and upper-level dominant spondylolisthesis. These findings suggest that degenerative changes in the cervical spine may also play a role in the onset and progression of DHS.

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Funding

No funds were received in support of this work. The authors have no relevant financial activities outside the submitted work to declare.

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Authors and Affiliations

  1. Department of Orthopedic Surgery, Showa University, 1-5-8 Hatanodai, Shinagawa-ku, Tokyo, 142-8666, Japan

    Yoshifumi Kudo, Tomoaki Toyone, Ichiro Okano, Koji Ishikawa, Soji Tani, Akira Matsuoka, Hiroshi Maruyama, Ryo Yamamura, Chikara Hayakawa, Koki Tsuchiya, Haruka Emori, Toshiyuki Shirahata, Yushi Hoshino, Tomoyuki Ozawa, Taiki Yasukawa & Katsunori Inagaki

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  1. Yoshifumi Kudo
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Contributions

Yoshifumi Kudo conceptualized, collected, and interpreted the clinical data, and wrote the manuscript. Tomoaki Toyone and Ichiro Okano and Koji Ishikawa contributed to design of the work and revised the manuscript critically for important intellectual content. Soji Tani, Akira Matsuoka, Hiroshi Maruyama, Ryo Yamamura, Chikara Hayakawa, Koki Tsuchiya, Toshiyuki Shirahata, Haruka Emori, Yushi Hoshino, Tomoyuki Ozawa, Taiki Yasukawa and Katsunori Inagaki contributed to data acquisition and revised the manuscript critically for important intellectual content. All authors read and approved the final manuscript.

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Correspondence to Yoshifumi Kudo.

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The authors declare that they have no conflicts of interest and no competing interests.

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The requirement for consent to participate was waived by the Showa University Institutional Review Board (IRB: 2020–3295).

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The requirement for consent for publication was waived by the Showa University Institutional Review Board (IRB: 2020–3295).

Research involving human participants

All procedures performed in studies involving human participants were in accordance with the ethical standards of the institutional and/or national research committee (Showa University Institutional Review Board [IRB: 2020–3295]) and with the 1964 Helsinki declaration and its later amendments or comparable ethical standards.

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Kudo, Y., Toyone, T., Okano, I. et al. Radiological features of cervical spine in dropped head syndrome: a matched case–control study. Eur Spine J 30, 3600–3606 (2021). https://doi.org/10.1007/s00586-021-06939-5

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  • DOI: https://doi.org/10.1007/s00586-021-06939-5

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