• Hiroshi Miyamoto.
• Department of Orthopedic Surgery, Kobe Rosai Hospital, Kobe, Japan. hiroshimiyamoto@hotmail.com.
• Eur Spine J. 2024 Sep 12.

BackgroundThis study aimed to elucidate the specificity of the radiological features of Dropped head syndrome (DHS) from both reginal and global aspects.MethodsWe enrolled 53 patients with DHS (8 men, 45 women; mean age 73.5 years), and captured their lateral spinopelvic radiographs in standing position. We also selected 21 age- and sex-matched controls with cervical spondylosis. Radiological parameters were measured and compared between two groups. Compensatory and decompensatory sites were also listed for each patient.ResultsRadiological factors such as sagittal vertical axis (SVA), clivo-axial angle (CAA), C2-7 angle, C2-7 SVA, anterior slippage of the vertebra, alignment. C1, C2, C3, C4, C5, C6 slopes, and T1 slope-C2-7 angle showed statistically significant differences between the groups. Multivariate logistic regression showed that SVA, C2-7 SVA, T1-slope-C2-7 angle, and C1 slope were the most important factors specific to DHS. Sole cervical spine and involvement of both cervical and thoracic spine accounted for 22% and 29% of the decompensatory sites in DHS respectively. Notably, 24% of the patients did not show decompensation of the cervical spine. While, 93% exhibited compensation at the craniovertebral junction. The thoracic spine contributed 70% to DHS compensation.ConclusionsThis study indicated the radiological features of DHS from both regional and global aspects. Compensatory and decompensatory DHS mechanisms varied among individuals. Compensation was likely to be developed at the neighboring sites, with the craniovertebral and thoracic junctions as the proximal and distal parts for DHS, respectively.© 2024. The Author(s), under exclusive licence to Springer-Verlag GmbH Germany, part of Springer Nature.

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