Resolution of low back symptoms after corrective surgery for dropped-head syndrome: a report of two cases
© Koda et al. 2015
Received: 19 March 2015
Accepted: 9 September 2015
Published: 7 October 2015
Cervical deformity can influence global sagittal balance. We report two cases of severe low back pain and lower extremity radicular pain associated with dropped-head syndrome. Symptoms were relieved by cervical corrective surgery.
Two Japanese women with dropped head syndrome complained of severe low back pain and lower extremity radicular pain on walking. Radiographs showed marked cervical spine kyphosis and lumbar spine hyperlordosis. After cervicothoracic posterior corrective fusion was performed, cervical kyphosis was corrected and lumbar lordosis decreased, and low back pain and leg pain were relieved in both patients.
Cervical deformity can influence global sagittal balance. Marked cervical kyphosis in patients with dropped-head syndrome can induce compensatory thoracolumbar hyperlordosis. Low back symptoms in patients with dropped-head syndrome are attributable to this compensatory lumbar hyperlordosis. Symptoms of lumbar canal stenosis may result from cervical deformity and can be improved with cervical corrective surgery.
Dropped-head syndrome is defined as apparent weakness of the neck extensor muscles that results in difficulty lifting the head against gravity and consequent impairment of activities of daily living. Its main symptoms include impaired forward vision, neck pain, and myelopathy and/or radiculopathy [1, 2].
We report two cases of severe low back pain and lower extremity radicular pain concomitant with dropped-head syndrome. The patients’ symptoms were relieved after cervical corrective surgery. The present manuscript confirmed to CARE checklist (Additional file 1).
The patient underwent laminectomy from C3 to C6 and posterior corrective fusion from C2 to T4, which corrected the cervical kyphosis. Postoperatively, the angle between C2 and C7 improved to 17.7°, T1 slope was 16.5°, lumbar lordosis decreased from 43.8° to 31.4°, and the patient experienced relief of her low back pain and bilateral leg pain.
Deformity of the thoracolumbar spine can induce cervical deformity . Smith et al. reported that patients with positive sagittal malalignment tend to compensate with cervical hyperlordosis to maintain horizontal gaze, and that surgical correction of thoracolumbar sagittal malalignment results in resolution of cervical hyperlordosis via reciprocal change. This spontaneous correction of cervical deformity after correction of global sagittal balance by lumbar pedicle subtraction osteotomy has been reported .
Conversely, cervical deformity can influence global sagittal balance. The marked cervical kyphosis observed in patients with dropped-head syndrome can induce compensatory thoracolumbar hyperlordosis. The patient in case 2 showed a postoperative increase in T1 slope, suggesting a compensatory extension of the thoracolumbar spine. Low back pain in patients with dropped-head syndrome is attributed to this compensatory mechanism. Extension of the lumbar spine can induce buckling of the yellow ligament and possibly resulting in exacerbation of lumbar canal stenosis and worsening associated symptoms . Therefore, patients with marked cervical kyphosis with compensatory lumbar hyperlordosis experience worsening symptoms of lumbar canal stenosis. If the hyperlordosis and hyperlordosis-related aggravation of lumbar canal stenosis symptoms are actually secondary to cervical kyphosis, low back symptoms can be resolved by correction of cervical kyphosis. In the present cases, compensatory lumbar hyperlordosis was mitigated by correction of cervical kyphosis.
Lumbar canal stenosis symptoms can result from cervical deformity and can be improved by cervical corrective surgery.
Written informed consent was obtained from both patients for publication of this Case Report and any accompanying images. A copy of the written consent is available for review by the Editor-in-Chief of this journal.
MK, TF, TI, KK, MO, and SM carried out the treatment and follow-up of the patients. OI obtained and assessed images of the patients. MA, KT, MY, and CM conceived of the study, participated in its design and coordination, and helped to draft the manuscript. All authors read and approved the final manuscript.
There is no source of funding for all authors.
The authors declare that they have no competing interests.
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