Chu Eric Chun-Pu, Trager Robert J, Lee Wai Ting, Tam Damien Ming Yan, Kwok Ronald
New York Chiropractic and Physiotherapy Centre, New York Medical Group, Kowloon, HKG.
Chiropractic, Connor Whole Health, University Hospitals Cleveland Medical Center, Cleveland, USA.
Cureus. 2023 Feb 9;15(2):e34796. doi: 10.7759/cureus.34796. eCollection 2023 Feb.
Dropped head syndrome is a rare disorder involving an inability to hold the head upright. It may be caused by a variety of neuromuscular disorders and occasionally by pathological vertebral fractures. A 79-year-old man presented to a chiropractor with a two-year history of gradual-onset chin-on-chest posture and increased thoracic kyphosis, which had failed to respond to physical therapy. The chiropractor ordered whole spine computed tomography which revealed extensive mixed lytic and sclerotic changes and multiple thoracic compression fractures suggestive of metastasis. The chiropractor promptly referred the patient to an oncologist, who performed a biopsy confirming prostate adenocarcinoma. The patient's health deteriorated, and he expired three weeks later. This case highlights that chiropractors should be aware that patients may present to their office with symptoms related to undiagnosed cancer, such as spinal deformity and dropped head syndrome. Chiropractors should order advanced imaging when patients have red flag signs or symptoms (e.g., older age, progressive symptoms despite care) and refer to an oncologist when clinical features or testing are suggestive of metastasis.
低头综合征是一种罕见的疾病，表现为无法将头部保持直立。它可能由多种神经肌肉疾病引起，偶尔也由病理性椎体骨折导致。一名79岁男性因逐渐出现的下巴抵胸姿势和胸椎后凸增加两年病史就诊于一名整脊师，物理治疗对此无效。整脊师安排了全脊柱计算机断层扫描，结果显示广泛的溶骨性和硬化性混合改变以及多处胸椎压缩性骨折，提示转移。整脊师迅速将患者转诊给一名肿瘤学家，后者进行活检确诊为前列腺腺癌。患者健康状况恶化，三周后死亡。该病例强调，整脊师应意识到患者可能因未确诊的癌症相关症状（如脊柱畸形和低头综合征）前来就诊。当患者出现警示体征或症状（如年龄较大、尽管接受治疗仍有进行性症状）时，整脊师应安排高级影像学检查，当临床特征或检查提示转移时，应转诊给肿瘤学家。
