Delayed neurological deterioration during halo-vest correction of dropped head syndrome after cervical laminoplasty in a 68-year-old man: a case report.
- 1Department of Spine Surgery, Shin-ai Kai Spine Center, Katano Hospital, Osaka, Japan.
- 2Department of Neurosurgery, Wakayama Medical University, Wakayama, Japan.
Abstract
Delayed neurological deterioration during gradual correction of dropped head syndrome (DHS) is clinically important because brief flexibility testing may not reproduce the effects of sustained realignment. We describe delayed myelopathic worsening during halo-vest correction after previous cervical laminoplasty. A 68-year-old man, 7 years after C3-6 laminoplasty, presented after 6 months of progressive chin-on-chest deformity and gait disturbance. Baseline findings included left-predominant limb weakness and atrophy, a left Babinski sign, a cervical Japanese Orthopaedic Association (JOA) score of 10.5, and preserved spontaneous urination. The C2-7 angle was -42.6 degrees. Dynamic magnetic resonance imaging (MRI) showed an intramedullary T2 high-signal lesion and posterior extradural tissue at C2/3 that enlarged in extension; anterior C2 translation relative to C3 measured 6.2 mm in flexion and 3.4 mm in extension (difference, 2.8 mm). Fifteen-minute fulcrum bending was tolerated. At halo-vest application, the deformity was corrected once, improving the C2-7 angle to -27.0 degrees; neurological examinations were performed twice daily. Gait progressively worsened on days 3-4, followed by urinary retention on day 4. The vest was removed on day 4 while the halo ring was retained until day 7; symptoms improved after release. Urgent MRI showed greater posterior tissue infolding and cord compression at C2/3. The surgical plan was changed to partial C2 laminectomy and C3 spacer removal, followed by C3-6 anterior fusion and staged C2-T2 posterior fixation. At 8 months, he walked independently, the JOA score was 15, and mild distal hand numbness and left-predominant weakness remained. Computed tomography at 18 months showed no radiolucent halo around the three anterior cages, consistent with interbody fusion, and continuous posterior bridging bone from C2 to T2. This single case suggests that sustained correction may expose time-dependent spinal cord compression not predicted by brief testing; it does not validate halo correction as a diagnostic test. Repeated motor, sensory, gait, and sphincter assessment during gradual realignment, with prompt release and urgent imaging for new deficits, may help prevent persistent neurological injury.
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BibTeX
@article{yamashita2026delayed,
title = {{Delayed neurological deterioration during halo-vest correction of dropped head syndrome after cervical laminoplasty in a 68-year-old man: a case report.}},
author = {Hokuto Yamashita and Nobuaki Naito and Takanobu Miyamoto and Shigeo Ueda and Nobuhiro Sasaki and Miyuki Fukuda and Atsuhiko Toyoshima and Masayuki Kuroda and Minoru Hoshimaru and Jiro Ohara},
journal = {Journal of spine surgery (Hong Kong)},
year = {2026},
month = sep,
doi = {10.21037/jss-2026-0155},
url = {https://europepmc.org/article/MED/42996605},
note = {CC BY-NC-ND},
}
RIS
TY - JOUR
TI - Delayed neurological deterioration during halo-vest correction of dropped head syndrome after cervical laminoplasty in a 68-year-old man: a case report.
AU - Hokuto Yamashita
AU - Nobuaki Naito
AU - Takanobu Miyamoto
AU - Shigeo Ueda
AU - Nobuhiro Sasaki
AU - Miyuki Fukuda
AU - Atsuhiko Toyoshima
AU - Masayuki Kuroda
AU - Minoru Hoshimaru
AU - Jiro Ohara
PY - 2026
DA - 2026/09/28
JO - Journal of spine surgery (Hong Kong)
DO - 10.21037/jss-2026-0155
UR - https://europepmc.org/article/MED/42996605
AB - Delayed neurological deterioration during gradual correction of dropped head syndrome (DHS) is clinically important because brief flexibility testing may not reproduce the effects of sustained realignment. We describe delayed myelopathic worsening during halo-vest correction after previous cervical laminoplasty. A 68-year-old man, 7 years after C3-6 laminoplasty, presented after 6 months of progressive chin-on-chest deformity and gait disturbance. Baseline findings included left-predominant limb weakness and atrophy, a left Babinski sign, a cervical Japanese Orthopaedic Association (JOA) score of 10.5, and preserved spontaneous urination. The C2-7 angle was -42.6 degrees. Dynamic magnetic resonance imaging (MRI) showed an intramedullary T2 high-signal lesion and posterior extradural tissue at C2/3 that enlarged in extension; anterior C2 translation relative to C3 measured 6.2 mm in flexion and 3.4 mm in extension (difference, 2.8 mm). Fifteen-minute fulcrum bending was tolerated. At halo-vest application, the deformity was corrected once, improving the C2-7 angle to -27.0 degrees; neurological examinations were performed twice daily. Gait progressively worsened on days 3-4, followed by urinary retention on day 4. The vest was removed on day 4 while the halo ring was retained until day 7; symptoms improved after release. Urgent MRI showed greater posterior tissue infolding and cord compression at C2/3. The surgical plan was changed to partial C2 laminectomy and C3 spacer removal, followed by C3-6 anterior fusion and staged C2-T2 posterior fixation. At 8 months, he walked independently, the JOA score was 15, and mild distal hand numbness and left-predominant weakness remained. Computed tomography at 18 months showed no radiolucent halo around the three anterior cages, consistent with interbody fusion, and continuous posterior bridging bone from C2 to T2. This single case suggests that sustained correction may expose time-dependent spinal cord compression not predicted by brief testing; it does not validate halo correction as a diagnostic test. Repeated motor, sensory, gait, and sphincter assessment during gradual realignment, with prompt release and urgent imaging for new deficits, may help prevent persistent neurological injury.
SN - 2414-469X
SN - 2414-4630
ER -