• World Neurosurg · Dec 2021

    Surgical Management of Post-Radiation, Dropped Head Spinal Deformity in Head and Neck Cancer Patients.

    • Terence Verla, Aditya Vedantam, Robert Y North, David S Xu, Michael R Raber, Alfonso Fuentes, Nelson Eddie Liou, and Alexander E Ropper.
    • Department of Neurosurgery, Baylor College of Medicine, Houston, Texas, USA. Electronic address: verla@bcm.edu.
    • World Neurosurg. 2021 Dec 1; 156: e1-e8.

    BackgroundDropped head syndrome is a morbid condition that affects daily functionality, causing pain and dysphagia and respiratory compromise. Reported causes of dropped head syndrome include neuromuscular disorders, iatrogenic from cervical spine surgery, and idiopathic and postradiation for head and neck cancers. Management of this spinal disorder remains challenging, as the complication rates are high. We present our series of 7 patients who underwent surgical correction of dropped head syndrome, all resulting from radiation for head and neck cancers.MethodsThis was a retrospective review of 7 patients who underwent surgery between 2016 and 2019 for dropped head syndrome secondary to postradiation cervical spine deformity. Clinical variables were obtained from medical records. Radiographic parameters pre- and postsurgery including T1 slope, sagittal vertical axis, and C2-C7 cervical lordosis were examined.ResultsSeven patients were included in the study, with an average age 69 years. Two patients underwent traction preoperatively. Five patients had posterior fixation and fusion only and 2 patients had a combined anterior and posterior fixation and fusion. Overall, there was improvement in average pre/postoperative sagittal vertical axis (6.96 cm to 3.04 cm), T1 slope (33.61° to 24.34°), and C2-C7 lordosis (-21.65° to -0.03°).ConclusionsSurgical correction of postradiation dropped head spinal deformity involving anterior and posterior fixation with osteotomies provides improvement in functional and radiographic outcomes as shown in our series. These cases are technically challenging and have a high rate of perioperative complications. Approaches must be tailored to the patient with attention to their specific surgical and radiation history.Copyright © 2021. Published by Elsevier Inc.

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