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Miyamoto H, Ikeda T, Akagi M. Conservative treatment for dropped head syndrome. EUROPEAN SPINE JOURNAL : OFFICIAL PUBLICATION OF THE EUROPEAN SPINE SOCIETY, THE EUROPEAN SPINAL DEFORMITY SOCIETY, AND THE EUROPEAN SECTION OF THE CERVICAL SPINE RESEARCH SOCIETY 2023; 32:3505-3510. [PMID: 37597042 DOI: 10.1007/s00586-023-07890-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/12/2023] [Revised: 06/13/2023] [Accepted: 08/06/2023] [Indexed: 08/21/2023]
Abstract
PURPOSE Previous reports on the outcome of conservative treatment for dropped head syndrome (DHS) are scarce. The purpose of this study was to elucidate the efficacy of conservative treatment for DHS and to identify possible predictive factors relating to the outcome. METHODS Among 76 DHS patients, conservative treatment (2-3 months collar application, active neck range of motion exercise, and occasional prescription of analgesics) succeeded in 17 patients (22.4%, group S, 4 male, 13 female, mean age 75.9 years). The treatment failed in the remaining 59 patients (group F). Clinical and radiological parameters were compared between the groups. Radiological findings of group S were compared between before treatment and at follow-up. RESULTS Duration of disease was 6.6 ± 9.3 months in group S and 20.0 ± 27.6 months in group F. C2-7 angle (degree), the incidence of anterior slippage of the vertebra (%), reducibility (%), and upper thoracic kyphosis angle (degree) in group S/F were - 19.2 ± 17.5/- 34.6 ± 26.6, 23.5/62.7, 100/52, and 6.7 ± 8.6/17.9 ± 13.7, respectively. C2-7 angles were - 19.2 ± 17.5 degrees at pre-treatment and 10.2 ± 20.7 degrees at follow-up. These differences were statistically significant. CONCLUSIONS The present study indicated that conservative treatment was successful in 22% of DHS patients, with improvement in their cervical kyphotic alignment. Shorter duration of disease, relatively smaller cervical kyphosis without anterior slippage of the vertebra, reducibility, and abundant compensation at the upper thoracic region were good indications for the success of conservative treatment.
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Affiliation(s)
- Hiroshi Miyamoto
- Department of Orthopedic Surgery, Kindai University Hospital, 377-2 Ohno-Higashi, Osaka-Sayama, Osaka, 589-851, Japan.
| | - Terumasa Ikeda
- Department of Orthopedic Surgery, Kindai University Hospital, 377-2 Ohno-Higashi, Osaka-Sayama, Osaka, 589-851, Japan
| | - Masao Akagi
- Department of Orthopedic Surgery, Kindai University Hospital, 377-2 Ohno-Higashi, Osaka-Sayama, Osaka, 589-851, Japan
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Igawa T, Ishii K, Urata R, Suzuki A, Ui H, Ideura K, Isogai N, Sasao Y, Funao H. Association between the Horizontal Gaze Ability and Physical Characteristics of Patients with Dropped Head Syndrome. Medicina (B Aires) 2022; 58:medicina58040465. [PMID: 35454304 PMCID: PMC9032265 DOI: 10.3390/medicina58040465] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/31/2021] [Revised: 03/18/2022] [Accepted: 03/21/2022] [Indexed: 11/16/2022] Open
Abstract
Background and Objectives: Patients with dropped head syndrome exhibit weakness of the cervical paraspinal muscles. However, the relationship between horizontal gaze disorder and physical function remains unclear. This study aimed to examine and clarify this relationship. Materials and Methods: Ninety-six patients with dropped head syndrome were included. We measured the McGregor’s Slope and investigated physical characteristics, including cervical muscle strength, back muscle strength, and walking ability. Factor analysis was used to classify the characteristics of physical function, and a linear multiple regression analysis was used to evaluate independent variables explaining the variance in the McGregor’s Slope. The physical functions of DHS patients were classified into three categories by factor analysis: limb and trunk muscle strength, walking ability, and neck muscle strength. Results: The average value of the McGregor’s Slope was 22.2 ± 24.0 degrees. As a result of multiple regression analysis, walking speed (β = −0.46) and apex (β = −0.30) were extracted as significant factors influencing the McGregor’s Slope. Conclusions: Horizontal gaze disorders are not associated with cervical muscle strength but with the walking ability and the alignment type of dropped head syndrome.
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Affiliation(s)
- Tatsuya Igawa
- Department of Orthopaedic Surgery, School of Medicine, International University of Health and Welfare, 852 Hatakeda, Narita City 286-8520, Japan; (N.I.); (Y.S.); (H.F.)
- Department of Orthopaedic Surgery, International University of Health and Welfare Mita Hospital, 1-4-3, Mita, Minato-ku, Tokyo 108-8329, Japan
- Spine and Spinal Cord Center, International University of Health and Welfare Mita Hospital, 1-4-3, Mita, Minato-ku, Tokyo 108-8329, Japan
- Department of Rehabilitation, International University of Health and Welfare Mita Hospital, 1-4-3, Mita, Minato-ku, Tokyo 108-8329, Japan; (R.U.); (A.S.); (H.U.); (K.I.)
- Department of Physical Therapy, School of Health Science, International University of Health and Welfare, 2600-1, Kitakanemaru, Ohtawara 323-8501, Japan
- Correspondence: (T.I.); (K.I.); Tel.: +81-476-35-5600 (T.I. & K.I.)
| | - Ken Ishii
- Department of Orthopaedic Surgery, School of Medicine, International University of Health and Welfare, 852 Hatakeda, Narita City 286-8520, Japan; (N.I.); (Y.S.); (H.F.)
- Department of Orthopaedic Surgery, International University of Health and Welfare Mita Hospital, 1-4-3, Mita, Minato-ku, Tokyo 108-8329, Japan
- Spine and Spinal Cord Center, International University of Health and Welfare Mita Hospital, 1-4-3, Mita, Minato-ku, Tokyo 108-8329, Japan
- Correspondence: (T.I.); (K.I.); Tel.: +81-476-35-5600 (T.I. & K.I.)
| | - Ryunosuke Urata
- Department of Rehabilitation, International University of Health and Welfare Mita Hospital, 1-4-3, Mita, Minato-ku, Tokyo 108-8329, Japan; (R.U.); (A.S.); (H.U.); (K.I.)
| | - Akifumi Suzuki
- Department of Rehabilitation, International University of Health and Welfare Mita Hospital, 1-4-3, Mita, Minato-ku, Tokyo 108-8329, Japan; (R.U.); (A.S.); (H.U.); (K.I.)
| | - Hideto Ui
- Department of Rehabilitation, International University of Health and Welfare Mita Hospital, 1-4-3, Mita, Minato-ku, Tokyo 108-8329, Japan; (R.U.); (A.S.); (H.U.); (K.I.)
| | - Kentaro Ideura
- Department of Rehabilitation, International University of Health and Welfare Mita Hospital, 1-4-3, Mita, Minato-ku, Tokyo 108-8329, Japan; (R.U.); (A.S.); (H.U.); (K.I.)
| | - Norihiro Isogai
- Department of Orthopaedic Surgery, School of Medicine, International University of Health and Welfare, 852 Hatakeda, Narita City 286-8520, Japan; (N.I.); (Y.S.); (H.F.)
- Department of Orthopaedic Surgery, International University of Health and Welfare Mita Hospital, 1-4-3, Mita, Minato-ku, Tokyo 108-8329, Japan
- Spine and Spinal Cord Center, International University of Health and Welfare Mita Hospital, 1-4-3, Mita, Minato-ku, Tokyo 108-8329, Japan
| | - Yutaka Sasao
- Department of Orthopaedic Surgery, School of Medicine, International University of Health and Welfare, 852 Hatakeda, Narita City 286-8520, Japan; (N.I.); (Y.S.); (H.F.)
- Department of Orthopaedic Surgery, International University of Health and Welfare Mita Hospital, 1-4-3, Mita, Minato-ku, Tokyo 108-8329, Japan
- Spine and Spinal Cord Center, International University of Health and Welfare Mita Hospital, 1-4-3, Mita, Minato-ku, Tokyo 108-8329, Japan
| | - Haruki Funao
- Department of Orthopaedic Surgery, School of Medicine, International University of Health and Welfare, 852 Hatakeda, Narita City 286-8520, Japan; (N.I.); (Y.S.); (H.F.)
- Department of Orthopaedic Surgery, International University of Health and Welfare Mita Hospital, 1-4-3, Mita, Minato-ku, Tokyo 108-8329, Japan
- Spine and Spinal Cord Center, International University of Health and Welfare Mita Hospital, 1-4-3, Mita, Minato-ku, Tokyo 108-8329, Japan
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Urata R, Igawa T, Suzuki A, Sasao Y, Isogai N, Funao H, Ishii K. The Short and Intensive Rehabilitation (SHAiR) Program Improves Dropped Head Syndrome Caused by Amyotrophic Lateral Sclerosis: A Case Report. Medicina (B Aires) 2022; 58:medicina58030452. [PMID: 35334628 PMCID: PMC8948869 DOI: 10.3390/medicina58030452] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/10/2022] [Revised: 03/17/2022] [Accepted: 03/18/2022] [Indexed: 11/18/2022] Open
Abstract
Background and Objectives: Dropped head syndrome (DHS) is a syndrome that presents with correctable cervical kyphotic deformity as a result of weakening cervical paraspinal muscles. DHS with amyotrophic lateral sclerosis (ALS) is a relatively rare condition, and there is no established treatment. This is the first case report describing the improvement of both dropped head (DH) and cervical pain after the short and intensive rehabilitation (SHAiR) program in an ALS patient with DHS. Case Report: After being diagnosed with ALS in June 2020, a 75-year-old man visited our hospital in October 2020 to receive treatment for DHS. At the initial visit, the patient’s DH was prominent during standing and walking. The pain intensity of the neck was 9 out of 10 on the numerical rating scale (NRS), which was indicative of severe pain. The patient was hospitalized for 2 weeks and admitted into the SHAiR program. DH began to decrease one week after undergoing the SHAiR program and improved two weeks later. Neck pain decreased from 9 to 6 on the NRS. Results: The SHAiR program is a rehabilitation program aimed at improving DH in patients with idiopathic DHS. The program was designed to improve neck extensor and flexor function and global spinal alignment, and the program may have contributed to the improvement of DH and neck pain. Currently, reports of conservative therapies for this disease are limited to the use of cervical orthosis. Although further research is needed on the safety and indications of treatment, the SHAiR program may be a viable treatment option.
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Affiliation(s)
- Ryunosuke Urata
- Department of Orthopaedic Surgery, School of Medicine, International University of Health and Welfare, Chiba 286-8520, Japan; (R.U.); (A.S.); (Y.S.); (N.I.)
- Department of Orthopaedic Surgery, School of Medicine, International University of Health and Welfare Narita Hospital, Chiba 286-8520, Japan
- Department of Orthopaedic Surgery, Spine and Spinal Cord Center, International University of Health and Welfare Mita Hospital, Tokyo 108-8329, Japan
- Department of Rehabilitation, International University of Health and Welfare Mita Hospital, Tokyo 108-8329, Japan
| | - Tatsuya Igawa
- Department of Orthopaedic Surgery, School of Medicine, International University of Health and Welfare, Chiba 286-8520, Japan; (R.U.); (A.S.); (Y.S.); (N.I.)
- Department of Orthopaedic Surgery, School of Medicine, International University of Health and Welfare Narita Hospital, Chiba 286-8520, Japan
- Department of Orthopaedic Surgery, Spine and Spinal Cord Center, International University of Health and Welfare Mita Hospital, Tokyo 108-8329, Japan
- Department of Rehabilitation, International University of Health and Welfare Mita Hospital, Tokyo 108-8329, Japan
- Department of Physical Therapy, School of Health Science, International University of Health and Welfare, Tochigi 323-8501, Japan
- Correspondence: (T.I.); (H.F.); (K.I.); Tel.: +81-476-35-5600 (K.I.)
| | - Akifumi Suzuki
- Department of Orthopaedic Surgery, School of Medicine, International University of Health and Welfare, Chiba 286-8520, Japan; (R.U.); (A.S.); (Y.S.); (N.I.)
- Department of Orthopaedic Surgery, School of Medicine, International University of Health and Welfare Narita Hospital, Chiba 286-8520, Japan
- Department of Orthopaedic Surgery, Spine and Spinal Cord Center, International University of Health and Welfare Mita Hospital, Tokyo 108-8329, Japan
| | - Yutaka Sasao
- Department of Orthopaedic Surgery, School of Medicine, International University of Health and Welfare, Chiba 286-8520, Japan; (R.U.); (A.S.); (Y.S.); (N.I.)
- Department of Orthopaedic Surgery, Spine and Spinal Cord Center, International University of Health and Welfare Mita Hospital, Tokyo 108-8329, Japan
| | - Norihiro Isogai
- Department of Orthopaedic Surgery, School of Medicine, International University of Health and Welfare, Chiba 286-8520, Japan; (R.U.); (A.S.); (Y.S.); (N.I.)
- Department of Orthopaedic Surgery, Spine and Spinal Cord Center, International University of Health and Welfare Mita Hospital, Tokyo 108-8329, Japan
| | - Haruki Funao
- Department of Orthopaedic Surgery, School of Medicine, International University of Health and Welfare, Chiba 286-8520, Japan; (R.U.); (A.S.); (Y.S.); (N.I.)
- Department of Orthopaedic Surgery, School of Medicine, International University of Health and Welfare Narita Hospital, Chiba 286-8520, Japan
- Department of Orthopaedic Surgery, Spine and Spinal Cord Center, International University of Health and Welfare Mita Hospital, Tokyo 108-8329, Japan
- Correspondence: (T.I.); (H.F.); (K.I.); Tel.: +81-476-35-5600 (K.I.)
| | - Ken Ishii
- Department of Orthopaedic Surgery, School of Medicine, International University of Health and Welfare, Chiba 286-8520, Japan; (R.U.); (A.S.); (Y.S.); (N.I.)
- Department of Orthopaedic Surgery, School of Medicine, International University of Health and Welfare Narita Hospital, Chiba 286-8520, Japan
- Department of Orthopaedic Surgery, Spine and Spinal Cord Center, International University of Health and Welfare Mita Hospital, Tokyo 108-8329, Japan
- Correspondence: (T.I.); (H.F.); (K.I.); Tel.: +81-476-35-5600 (K.I.)
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