Correction of dropped head deformity through combined anterior and posterior osteotomies to restore horizontal gaze and improve sagittal alignment

[Figure not available: see fulltext.] Objective: The aim of this study is to present our technique for a large focal correction of a partially flexible dropped head deformity through combined anterior and posterior osteotomies, as well as anterior soft tissue releases. Methods: One patient with dropped head deformity underwent an anterior and posterior osteotomy with anterior soft tissue release. Results: The patient recovered well, with postoperative radiographs demonstrating significant improvement in coronal and sagittal alignment. His C2–C7 sagittal vertical axis improved from 7.5 cm preoperatively to less than 4 cm postoperatively and his C2–C7 sagittal Cobb improved from 35° of kyphosis to 10° of lordosis. Conclusion: In this report, we present our technique for a large focal correction of a partially flexible dropped head deformity through combined anterior and posterior osteotomies and anterior soft tissue releases. These more conservative osteotomies permitted gradual deformity correction and alleviated the need for pedicle subtraction osteotomy. We were able to restore horizontal gaze and improve sagittal malalignment. Although the technique we present here is one of many possible options for managing the deformity, we believe this combined approach is safe and effective and well tolerated by patients.