Radiographic Outcomes of the Short and Intensive Rehabilitation (SHAiR) Program in Patients with Dropped Head Syndrome

Norihiro Isogai; Ken Ishii; Tatsuya Igawa; Kentaro Ideura; Yutaka Sasao; Haruki Funao

doi:10.2106/JBJS.OA.23.00016

Radiographic Outcomes of the Short and Intensive Rehabilitation (SHAiR) Program in Patients with Dropped Head Syndrome

JB JS Open Access. 2023 Sep 20;8(3):e23.00016. doi: 10.2106/JBJS.OA.23.00016. eCollection 2023 Jul-Sep.

Authors

Norihiro Isogai^{1

2

3}, Ken Ishii^{4

5

6}, Tatsuya Igawa^{7

8}, Kentaro Ideura⁷, Yutaka Sasao^{1

2

3}, Haruki Funao^{1

2

3

9}

Affiliations

¹ Department of Orthopaedic Surgery, School of Medicine, International University of Health and Welfare (IUHW), Chiba, Japan.
² Spine and Spinal Cord Center, IUHW Mita Hospital, Tokyo, Japan.
³ Department of Orthopaedic Surgery, IUHW Mita Hospital, Tokyo, Japan.
⁴ Department of Orthopaedic Surgery, Keio University School of Medicine, Tokyo, Japan.
⁵ Society for Minimally Invasive Spinal Treatment (MIST), Tokyo, Japan.
⁶ Department of Orthopaedic Surgery, Edogawa Hospital, Tokyo Japan.
⁷ Department of Rehabilitation, IUHW Mita Hospital, Tokyo, Japan.
⁸ Department of Physical Therapy, Faculty of Health Science, IUHW, Tochigi, Japan.
⁹ Department of Orthopaedic Surgery, IUHW Narita Hospital, Chiba, Japan.

Abstract

Background: The radiographic outcomes of nonoperative treatment of dropped head syndrome are still unknown. The purpose of the present study was to assess the change in sagittal spinopelvic radiographic parameters after the short and intensive rehabilitation (SHAiR) program in patients with dropped head syndrome.

Methods: This study included 48 consecutive patients with dropped head syndrome who presented with an inability to maintain horizontal gaze and who underwent the SHAiR program during the period of 2018 to 2019. Patients were divided into 2 groups according to their ability to maintain horizontal gaze at the time of final follow-up: those who had regained horizontal gaze (the "effective" group) and those who had not regained horizontal gaze (the "noneffective" group). Sagittal radiographic parameters including the sagittal vertical axis (SVA), the C2-7 angle, the C2-7 SVA, T1 slope, thoracic kyphosis of T1-5 and T5-12, lumbar lordosis, pelvic tilt, pelvic incidence, sacral slope, and curve flexibility, and demographic data and clinical outcomes were compared between the 2 groups using an unpaired t test, chi-square test, and Fisher exact test, as appropriate.

Results: Thirty-five patients in the effective group and 13 patients in the noneffective group were analyzed. The rate of response in regaining horizontal gaze with the SHAiR program was 73%. The C2-7 angle, the C2-7 SVA, T1 slope, and thoracic kyphosis (T1-5) demonstrated significant correction in the effective group (p < 0.05). There were no significant changes in other parameters below the mid-thoracic spine-i.e., the thoracolumbar and lumbar spine and pelvis-following the SHAiR program. Scores of the Neck Disability Index and visual analog scale for pain improved significantly in both groups.

Conclusions: The SHAiR program improved horizontal gaze among a large percentage of our patients and reduced cervical pain among patients overall. The correction of thoracic kyphosis (T1-5) might be an important treatment target to restore the appropriate T1 tilt in patients with dropped head syndrome.

Level of evidence: Therapeutic Level III. See Instructions for Authors for a complete description of levels of evidence.