Funao Haruki, Isogai Norihiro, Ishii Ken
Department of Orthopaedic Surgery, School of Medicine, International University of Health and Welfare (IUHW), Japan.
Spine and Spinal Cord Center, IUHW Mita Hospital, Japan.
Heliyon. 2020 Aug 22;6(8):e04774. doi: 10.1016/j.heliyon.2020.e04774. eCollection 2020 Aug.
A 78 year-old female presented with dropped head syndrome (DHS). Three months before her initial visit to our hospital, the patient noticed a pronounced flexion of her head and neck with subsequent deterioration of symptoms, which included neck pain, difficulty with forward gaze, and gait disturbance. Cervical radiographs demonstrated scoliotic and kyphotic changes, and her symptom deteriorated over time, especially in the standing position. Duloxetine was administered for her low back pain because nonsteroidal anti-inflammatory drugs deemed ineffective. The patient demonstrated marked improvements in both radiographic and clinical appearances after 4 months. Her neck pain decreased from 8 to 2 out of 10 in the Numeric Rating Scale, and her symptoms such as difficulty with forward gaze and gait disturbance had also resolved. Duloxetine is a serotonin noradrenaline reuptake inhibitor that is usually used for chronic musculoskeletal pain, neuropathic pain, or depression. In this report, we present another potential application of duloxetine in the treatment of DHS. The following possibilities were considered for the improved outcomes: (1) pain relief may have helped the patient feel comfortable enough to move her neck, and (2) we suppose that serotonin and noradrenaline reuptake may contribute to the improvement of DHS, because there might be a potential disequilibrium of neurotransmitters such as serotonin, dopamine and noradrenaline in DHS patients. Although further investigation is needed to clarify the mechanism, duloxetine should be considered as one of the optional treatments for DHS.
一名78岁女性因低头综合征（DHS）就诊。在初次到我院就诊前三个月，患者注意到头部和颈部明显屈曲，随后症状恶化，包括颈部疼痛、向前注视困难和步态障碍。颈椎X线片显示有脊柱侧弯和后凸改变，且她的症状随时间推移而恶化，尤其是在站立位时。因非甾体类抗炎药被认为无效，故给予度洛西汀治疗她的下背部疼痛。4个月后，患者的影像学和临床表现均有明显改善。她的颈部疼痛在数字评分量表上从10分中的8分降至2分，她的向前注视困难和步态障碍等症状也已消失。度洛西汀是一种血清素去甲肾上腺素再摄取抑制剂，通常用于治疗慢性肌肉骨骼疼痛、神经性疼痛或抑郁症。在本报告中，我们展示了度洛西汀在治疗DHS方面的另一种潜在应用。对于病情改善考虑了以下可能性：（1）疼痛缓解可能有助于患者感觉舒适到足以活动颈部；（2）我们推测血清素和去甲肾上腺素再摄取可能有助于改善DHS，因为DHS患者中可能存在血清素、多巴胺和去甲肾上腺素等神经递质的潜在失衡。尽管需要进一步研究以阐明其机制，但度洛西汀应被视为DHS的可选治疗方法之一。
