Luigi Caruso1, Giuseppe Barone, Andrea Farneti, Auro Caraffa. 1. Division of Orthopedic and Traumatology, University of the Study of Perugia, Hospital "S. Maria della Misericordia", Via Ruggero Leoncavallo n.12, 06132, Perugia, Italy.
Abstract
PURPOSE: Chin-on-chest deformity is a rare and severe condition mostly related with ankylosing spondylitis, traumas and/or cervical spine surgery. We present a case of 69 years old woman with a rare form of chin-on-chest secondary to dropped head syndrome (DHS), developed after radiotherapy for Hodgkin disease. In addition, we reviewed the few publications about this specific condition; management and surgical treatment of DHS are discussed. METHODS: We performed a pedicle subtraction osteotomy (PSO) and stabilization through a posterior approach. Intraoperative monitoring using motor and somatosensory evoked potentials and wake-up test were carried out. RESULTS: At 19th month follow-up, the patient reported a significant improvement of cervical pain, dysphagia and respiratory difficulty and a complete restoration of the neurological impairment. The achieved correction was successful and the patient was very satisfied by the restoration of forward gaze. CONCLUSIONS: DHS is a very rare post-radiotherapy complication; there is lack of evidences in literature about its management. The only definitive treatment seems to be surgical intervention. PSO is a valid therapeutic option when fixed chin-on-chest deformity occurs; although it is a demanding technique and it presents high rate of complications, the actual neurological monitoring methods provide more intraoperative safety.
PURPOSE: Chin-on-chest deformity is a rare and severe condition mostly related with ankylosing spondylitis, traumas and/or cervical spine surgery. We present a case of 69 years old woman with a rare form of chin-on-chest secondary to dropped head syndrome (DHS), developed after radiotherapy for Hodgkin disease. In addition, we reviewed the few publications about this specific condition; management and surgical treatment of DHS are discussed. METHODS: We performed a pedicle subtraction osteotomy (PSO) and stabilization through a posterior approach. Intraoperative monitoring using motor and somatosensory evoked potentials and wake-up test were carried out. RESULTS: At 19th month follow-up, the patient reported a significant improvement of cervical pain, dysphagia and respiratory difficulty and a complete restoration of the neurological impairment. The achieved correction was successful and the patient was very satisfied by the restoration of forward gaze. CONCLUSIONS:DHS is a very rare post-radiotherapy complication; there is lack of evidences in literature about its management. The only definitive treatment seems to be surgical intervention. PSO is a valid therapeutic option when fixed chin-on-chest deformity occurs; although it is a demanding technique and it presents high rate of complications, the actual neurological monitoring methods provide more intraoperative safety.
Authors: P Petiot; C Vial; J F de Saint Victor; N Charles; H Carrier; P Depierre; B Bady Journal: Rev Neurol (Paris) Date: 1997-05 Impact factor: 2.607
Authors: Yongjung J Kim; Keith H Bridwell; Lawrence G Lenke; Gene Cheh; Christine Baldus Journal: Spine (Phila Pa 1976) Date: 2007-09-15 Impact factor: 3.468
Authors: Timothy G Petheram; Patrick G Hourigan; Ihab M Emran; Christopher R Weatherley Journal: Spine (Phila Pa 1976) Date: 2008-01-01 Impact factor: 3.468
Authors: Justin S Smith; Christopher I Shaffrey; Han Jo Kim; Peter Passias; Themistocles Protopsaltis; Renaud Lafage; Gregory M Mundis; Eric Klineberg; Virginie Lafage; Frank J Schwab; Justin K Scheer; Michael Kelly; D Kojo Hamilton; Munish Gupta; Vedat Deviren; Richard Hostin; Todd Albert; K Daniel Riew; Robert Hart; Doug Burton; Shay Bess; Christopher P Ames Journal: Global Spine J Date: 2018-08-16