1407 - Dropped Head Syndrome Following Unilateral Cervical Radiofrequency Ablation

Thursday, February 19, 2026

5:00 PM - 6:30 PM AST

Presenting Author(s)

SS

Sahil Shah, MD

Resident Physician
Rutgers Health/Community Medical Center
North brunswick, New Jersey, United States

Corresponding Author(s)

BC

Boqing Chen, MD

Clinical Associate Professor
Center for Adv. Pain MAMG
Metuchen, New Jersey, United States

Co-Author(s)

PF

Patrick M. Foye, M.D.

Professor of Physical Medicine & Rehabilitation, Director of the Coccyx Pain Center,
Rutgers New Jersey Medical School
Newark, New Jersey, United States
TS

Todd P. Stitik, MD

Professor of Physical Medicine and Rehabilitation
Rutgers, New Jersey Medical School
Newark, New Jersey, United States

Submitter(s)

SS

Sahil Shah, MD

Rutgers Health/Community Medical Center
North brunswick, New Jersey, United States

Case Diagnosis: We present a case of Dropped Head Syndrome (DHS) following unilateral multilevel cervical radiofrequency ablation (RFA).

Case Description: A 68-year-old male with diabetes presented with a five-year history of progressive left-sided neck and shoulder pain, radiating to his head and worsened with left neck rotation. Previous physical therapy and trigger point injections failed. Left-sided medial branch blocks at C6–C7 and C7–T1 facet joints provided greater than 80% but short-lived relief. One month later, he underwent left-sided RFA at the same levels. Three months afterwards, he developed progressive neck stiffness and difficulty maintaining a neutral or extended posture. Examination revealed a “dropped head” with cervical spine extensor weakness, flexor muscle tightness, and reduced range of motion. Needle EMG demonstrated denervation of cervical, thoracic, and lumbar paraspinal muscles with spared upper and lower limb muscles; nerve conduction studies showed only mild slowing across his elbows. MRI showed loss of cervical lordosis and multilevel cervical disc herniations. After cervical collar placement and continued physical therapy, his symptoms resolved over three months.

Discussions: Paraspinal extensor muscles are innervated by medial branches of the dorsal rami. While medial branch blocks are reversible, RFA produces thermal lesions that can denervate both sensory innervation of facet joints and paraspinal intrinsic muscles. DHS has been reported after bilateral or extensive multilevel RFA, but this is the first reported case following strictly unilateral cervical RFA. This patient's diabetes may have further contributed by predisposing paraspinal denervation.

Conclusions: This is the first case report of DHS following strictly unilateral cervical RFA. Bilateral paraspinal weakness may occur after RFA due to iatrogenic denervation of deep extensor muscles, particularly in the setting of diabetes. Careful patient selection, procedural staging, and vigilant follow-up with post RFA physical therapy are essential to reduce risk of this rare complication.