Dropped head syndrome or head ptosis is a reducible flexion deformity of the neck that is caused from a weakness of the extensor muscles or increased tone of the flexor muscles of the neck resulting in the chin-on-chest deformity and at the extreme the patient will be unable to look straight ahead [1-6].
Isolated dropped head syndrome proceeding cervical spondylotic myelopathy and their ultimate association is quite rare.
Herein, a new case of cervical myelopathy developing two years after the appearance of dropped head syndrome, as a sequel of isolated neck extensor myopathy, is presented and a brief review of the literature on the condition is also provided [11-14].
Development of cervical spondylotic myopathy a few years after appearance of dropped head syndrome is a rare scenario.
However, the rarity of this association remains a question, if we accept the fact that dropped head syndrome due to INEM is confined to the elderly and in this age group asymptomatic cervical spondylosis is not infrequent.
Nonetheless, coexistence of dropped head syndrome (DHS) and cervical spondylotic myelopathy (CSM) sooner or later will severely compromise the patient's quality of life and may result in significant disability if left untreated [11-14].
Moreover, severe osteoporosis which coexists in the elderly with dropped head syndrome may complicate laminectomy plus posterior instrumentation.
Therefore, it seems that it is better to extend the construct to the upper thoracic spine in all the patients who suffer from dropped head syndrome in isolation or as a combined pathology [2, 3, 14, 17-19], in particular with consideration of the natural course of INEM which might be the progression of isolated myopathy to the muscles of the upper thoracic spine with time .
In contrast to the dropped head syndrome secondary to serious neuromuscular diseases, which usually have a grave prognosis, in the combination of INEM and CSM, the outcome depends on the time of the surgery.
In summary, progression of spondylotic changes with appearance of myelopathy should be expected in a patient with dropped head syndrome as a sequel of INEM.
Abbreviations DHS: Dropped head syndrome CSM: Cervical spondylotic myelopathy.
Weatherley, "Dropped head syndrome: a case series and literature review, " Spine, vol.