Relationship between cervical and global sagittal balance in patients with dropped head syndrome

Eur Spine J. 2020 Mar;29(3):413-419. doi: 10.1007/s00586-019-06229-1. Epub 2020 Jan 14.


Background: DHS is characterized by chin-on-chest deformity and devastatingly impedes activities of daily living in affected individuals. There is a paucity of literature about the pathophysiology of DHS including knowledge about spinal sagittal alignment. We conducted this study to clarify the relationship between cervical sagittal alignment and global sagittal balance in DHS.

Methods: This is a retrospective radiographic study of a case series of DHS. Forty-one patients with diagnosed DHS were enrolled. Measurements were made using lateral standing radiograph.

Results: C2-C7 sagittal vertical axis (SVA) was estimated as 52.0 ± 2.4 mm. Among sagittal parameters, C7-S1 SVA positively correlated with C2-C7 angle (C2-C7 A) (r = 0.33). For the correlations between C7 and S1 SVA and C2-C7 A, both logistic and linear regression models were used to determine the threshold for C2-C7 A value responsible for global sagittal balance. C2-C7 A of - 15.0 and 6.0 were predicted by logistic and linear regression models and were considered responsible for the occurrence of global positive imbalance. Therefore, we divided into two groups, namely, cervical kyphosis group (C type) and diffuse kyphosis group (D type) by median value of C2-C7 A. Enlarged thoracic kyphosis and global positive imbalance were observed in D type compared to C type.

Conclusion: C2-C7 A exhibited correlations with cervical balance and also with global balance. There should be various type of thoraco-lumbar alignment in DHS. These slides can be retrieved under Electronic Supplementary Material.

Keywords: Cervical deformity; Dropped head syndrome; Sagittal alignment; Sagittal balance.

MeSH terms

  • Activities of Daily Living
  • Cervical Vertebrae* / diagnostic imaging
  • Cervical Vertebrae* / pathology
  • Cervical Vertebrae* / physiopathology
  • Humans
  • Posture / physiology*
  • Radiography
  • Retrospective Studies
  • Spinal Curvatures* / diagnostic imaging
  • Spinal Curvatures* / pathology
  • Spinal Curvatures* / physiopathology
  • Syndrome