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Spinal Sagittal Alignment in Patients With Dropped Head Syndrome.
Spine (Phila Pa 1976). 2018 Nov 01; 43(21):E1267-E1273.S

Abstract

STUDY DESIGN

This is a retrospective radiographic study of a consecutive case series of dropped head syndrome (DHS) at a single tertiary referral center.

OBJECTIVE

The aim was to clarify the spinal sagittal alignment of DHS.

SUMMARY OF BACKGROUND DATA

DHS is characterized by chin-on-chest deformity and devastatingly impedes activities of daily living in affected individuals. Among various forms of DHS, isolated neck extensor myopathy (INEM) is considered to cause the chin-on-chest symptom in the absence of specific abnormality. There is a paucity of literature about spinal sagittal alignment, of this condition however.

METHODS

Thirty-seven patients diagnosed with INEM DHS were enrolled. Radiographic measurements were made, including the following parameters: C2 slope (C2S), C2-C7 A, C2-C7 sagittal vertical axis (SVA), T1 slope (T1S), C7-S1 SVA, T1-T4 thoracic kyphosis (TK), T4-T12 TK, lumbar lordosis (LL), sacral slope (SS), pelvic tilt (PT), and pelvic incidence (PI). Sixty-one patients with cervical spondylosis were enrolled as a control group.

RESULTS

C2-C7 SVA was greater in INEM DHS (52.0 ± 2.9 vs. 18.6 ± 1.9 mm). C2S and T1S were larger to the control (C2S: 52.6° ± 2.0° vs. 13.0° ± 1.4°, T1S: 37.3° ± 2.2° vs. 22.7° ± 1.4°). C2-C7 A was smaller in INEM DHS (-7.8° ± 2.6° vs. 15.2° ± 2.7°). Among sagittal parameters, C2S, T1S, and T1-T4 TK positively correlated with C2-C7 SVA (r = 0.63, r = 0.54, and r = 0.58). For these correlations with C2-C7 SVA, both logistic and linear regression models predicted threshold of 40° for C2S, 40° for T1S, and 15° for T1-T4 TK responsible for C2-C7 SVA > 40 mm, respectively.

CONCLUSION

Increased offset of the gravity axis of the head represented by C2-C7 SVA was observed in INEM DHS. Magnified offset of the gravity axis of the head was affected by enlarged C2S, T1S, and T1-T4 TK for the strong correlation with C2-C7 SVA, respectively. Cervical kyphosis was considered as some of the anthropometric characteristics due to regressive changes in affected individuals; a correlation between C2-C7 A and C2-C7 SVA was exhibited.

LEVEL OF EVIDENCE

4.

Authors+Show Affiliations

Department of Orthopedic Surgery, Tokyo, Medical University, Tokyo, Japan.No affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info available

Pub Type(s)

Journal Article

Language

eng

PubMed ID

29664814

Citation

Murata, Kazuma, et al. "Spinal Sagittal Alignment in Patients With Dropped Head Syndrome." Spine, vol. 43, no. 21, 2018, pp. E1267-E1273.
Murata K, Kenji E, Suzuki H, et al. Spinal Sagittal Alignment in Patients With Dropped Head Syndrome. Spine (Phila Pa 1976). 2018;43(21):E1267-E1273.
Murata, K., Kenji, E., Suzuki, H., Takamatsu, T., Nishimura, H., Matsuoka, Y., Sawaji, Y., Tanaka, H., & Yamamoto, K. (2018). Spinal Sagittal Alignment in Patients With Dropped Head Syndrome. Spine, 43(21), E1267-E1273. https://doi.org/10.1097/BRS.0000000000002685
Murata K, et al. Spinal Sagittal Alignment in Patients With Dropped Head Syndrome. Spine (Phila Pa 1976). 2018 Nov 1;43(21):E1267-E1273. PubMed PMID: 29664814.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - Spinal Sagittal Alignment in Patients With Dropped Head Syndrome. AU - Murata,Kazuma, AU - Kenji,Endo, AU - Suzuki,Hidekazu, AU - Takamatsu,Taichiro, AU - Nishimura,Hirosuke, AU - Matsuoka,Yuji, AU - Sawaji,Yasunobu, AU - Tanaka,Hidetoshi, AU - Yamamoto,Kengo, PY - 2018/4/18/pubmed PY - 2019/6/1/medline PY - 2018/4/18/entrez SP - E1267 EP - E1273 JF - Spine JO - Spine (Phila Pa 1976) VL - 43 IS - 21 N2 - STUDY DESIGN: This is a retrospective radiographic study of a consecutive case series of dropped head syndrome (DHS) at a single tertiary referral center. OBJECTIVE: The aim was to clarify the spinal sagittal alignment of DHS. SUMMARY OF BACKGROUND DATA: DHS is characterized by chin-on-chest deformity and devastatingly impedes activities of daily living in affected individuals. Among various forms of DHS, isolated neck extensor myopathy (INEM) is considered to cause the chin-on-chest symptom in the absence of specific abnormality. There is a paucity of literature about spinal sagittal alignment, of this condition however. METHODS: Thirty-seven patients diagnosed with INEM DHS were enrolled. Radiographic measurements were made, including the following parameters: C2 slope (C2S), C2-C7 A, C2-C7 sagittal vertical axis (SVA), T1 slope (T1S), C7-S1 SVA, T1-T4 thoracic kyphosis (TK), T4-T12 TK, lumbar lordosis (LL), sacral slope (SS), pelvic tilt (PT), and pelvic incidence (PI). Sixty-one patients with cervical spondylosis were enrolled as a control group. RESULTS: C2-C7 SVA was greater in INEM DHS (52.0 ± 2.9 vs. 18.6 ± 1.9 mm). C2S and T1S were larger to the control (C2S: 52.6° ± 2.0° vs. 13.0° ± 1.4°, T1S: 37.3° ± 2.2° vs. 22.7° ± 1.4°). C2-C7 A was smaller in INEM DHS (-7.8° ± 2.6° vs. 15.2° ± 2.7°). Among sagittal parameters, C2S, T1S, and T1-T4 TK positively correlated with C2-C7 SVA (r = 0.63, r = 0.54, and r = 0.58). For these correlations with C2-C7 SVA, both logistic and linear regression models predicted threshold of 40° for C2S, 40° for T1S, and 15° for T1-T4 TK responsible for C2-C7 SVA > 40 mm, respectively. CONCLUSION: Increased offset of the gravity axis of the head represented by C2-C7 SVA was observed in INEM DHS. Magnified offset of the gravity axis of the head was affected by enlarged C2S, T1S, and T1-T4 TK for the strong correlation with C2-C7 SVA, respectively. Cervical kyphosis was considered as some of the anthropometric characteristics due to regressive changes in affected individuals; a correlation between C2-C7 A and C2-C7 SVA was exhibited. LEVEL OF EVIDENCE: 4. SN - 1528-1159 UR - https://www.unboundmedicine.com/medline/citation/29664814/Spinal_Sagittal_Alignment_in_Patients_With_Dropped_Head_Syndrome_ L2 - https://doi.org/10.1097/BRS.0000000000002685 DB - PRIME DP - Unbound Medicine ER -