# The Occurrence of Dropped Head Syndrome After a Cervical Medial Branch Nerve Block in a Patient With Cervicothoracic Kyphotic Deformity: A Case Report

## TL;DR

A 69-year-old woman developed dropped head syndrome after cervical medial branch nerve blocks, highlighting a rare complication requiring long-term management.

## Contribution

This case report documents a rare occurrence of dropped head syndrome following cervical medial branch blocks.

## Key findings

- Dropped head syndrome occurred after cervical medial branch blocks using short-acting anesthetics.
- The patient experienced persistent symptoms for over six months without surgical intervention.
- Physical therapy and a cervical collar were used for non-surgical management.

## Abstract

Complications from medial branch blocks (MBBs) are rare when following proper procedural protocol. Dropped head syndrome (DHS) is characterized by profound muscle weakness in the cervical spine, resulting in a failure to maintain a level horizontal gaze and, in the worst cases, a chin-on-chest deformity. In this case report, we described DHS developing after cervical MBBs using short-acting anesthetic agents and subsequent management. A 69-year-old woman with a previous C6-C7 anterior cervical discectomy and fusion (ACDF) underwent bilateral posterior cervical MBBs targeting the C4-C5 and C5-C6 levels. Immediately following the injection, she reported a sudden inability to lift her head and was subsequently diagnosed with DHS. This condition continued with minimal improvement for over six months. After weighing the risks, the patient elected to avoid surgery, and she was provided a soft cervical collar and prescribed physical therapy. DHS is a debilitating condition more commonly associated with neurodegenerative conditions and inflammatory myopathy, which has received limited attention due to its rarity as a complication of cervical radiofrequency neurotomy. Surgery for this condition, when considered, typically involves long-segment posterior cervical instrumented fusion. Undergoing such a surgery is a complicated discussion that should consider patient clinical factors and preferences. The clinical impact of loss of strength in paraspinal musculature in this patient population is clearly deserving of further study.