title: Pedicle subtraction osteotomy for the treatment of chin-on-chest deformity in a post-radiotherapy dropped head syndrome: a case report and review of literature.
abstract: OBJECTIVE
  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.
  
  
  METHODS
  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.
  
  
  RESULTS
  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.
  
  
  CONCLUSIONS
  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.
authors.affiliation: Division of Orthopedic and Traumatology, University of the Study of Perugia, Hospital "S. Maria della Misericordia", Via Ruggero Leoncavallo n.12, 06132, Perugia, Italy.
authors.forename: Luigi
authors.initials: L
authors.lastname: Caruso
authors.forename: Giuseppe
authors.initials: G
authors.lastname: Barone
authors.forename: Andrea
authors.initials: A
authors.lastname: Farneti
authors.forename: Auro
authors.initials: A
authors.lastname: Caraffa
mesh_terms: D000368:Aged; D005260:Female; D006689:Hodgkin Disease / Q000532:radiotherapy; D006801:Humans; D007738:Kyphosis / Q000000981:diagnostic imaging / Q000209:etiology / Q000601:surgery*; D016343:Monitoring, Intraoperative / Q000379:methods; D019547:Neck Pain / Q000209:etiology / Q000601:surgery; D010027:Osteotomy / Q000379:methods*; D011832:Radiation Injuries / Q000000981:diagnostic imaging / Q000209:etiology / Q000601:surgery*; D011859:Radiography; D011878:Radiotherapy / Q000009:adverse effects; D016896:Treatment Outcome