Caruso Luigi, Barone Giuseppe, Farneti Andrea, Caraffa Auro
Division of Orthopedic and Traumatology, University of the Study of Perugia, Hospital "S. Maria della Misericordia", Via Ruggero Leoncavallo n.12, 06132, Perugia, Italy.
Eur Spine J. 2014 Oct;23 Suppl 6:634-43. doi: 10.1007/s00586-014-3544-z. Epub 2014 Sep 13.
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.
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.
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.
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.
颏胸畸形是一种罕见且严重的病症，主要与强直性脊柱炎、创伤和/或颈椎手术有关。我们报告一例69岁女性患者，其患有因霍奇金病放疗后发生的低头综合征（DHS）继发的罕见类型的颏胸畸形。此外，我们回顾了关于这种特殊病症的少量文献，并讨论了DHS的管理和手术治疗。
我们通过后路进行椎弓根截骨术（PSO）及稳定手术。术中采用运动和体感诱发电位监测及唤醒试验。
在第19个月的随访中，患者报告颈部疼痛、吞咽困难和呼吸困难有显著改善，神经功能障碍完全恢复。实现的矫正成功，患者对前视恢复非常满意。
DHS是一种非常罕见的放疗后并发症；文献中缺乏关于其管理的证据。唯一确定的治疗方法似乎是手术干预。当出现固定的颏胸畸形时，PSO是一种有效的治疗选择；尽管它是一项要求较高的技术且并发症发生率高，但实际的神经监测方法可提供更高的术中安全性。
