Geriatric Dropped Head Syndrome from Multi-Level Cervical Instability with Compression Fracture and Severe Frailty: A Rare Case of Complex Postural Collapse<b><i></i></b>

Background: Dropped Head Syndrome (DHS) is an uncommon clinical entity, and its occurrence secondary to multi-level cervical instability with a compression fracture in a frail, underweight geriatric patient is exceptionally rare. The complexity is further heightened by comorbid inanition, postural instability, and visual impairment, creating profound challenges for both diagnosis and rehabilitation management. Case Presentation: A 66-year-old severely underweight woman presented with a four-month history of progressive chin-on-chest posture, hyperkyphotic trunk alignment, and inability to maintain horizontal gaze. Imaging revealed a C4–C5 compression fracture with posterior angulation and grade II anterolisthesis superimposed on multi-level cervical degeneration. Laboratory and geriatric assessment confirmed severe malnutrition, osteoporosis, balance impairment, and bilateral cataract. Rehabilitation Intervention: A four-week multidisciplinary inpatient rehabilitation program addressed cervical orthotic support, cervical and trunk extensor strengthening, global postural retraining, balance and gait training, nutritional supplementation, pain management, and environmental modification for low vision. Outcome: After four weeks, the patient achieved improved head elevation tolerance, reduced pain (VAS 6/10 to 2/10), and greater independence in basic activities (Barthel Index 65 to 90). Gait stability improved with a four-wheeled walker; however, the structural cervical deformity persisted on radiographic follow-up. Conclusion: This case represents a rare confluence of structural cervical pathology and multisystem geriatric frailty producing DHS. Intensive, individualized, ICF-guided, multidisciplinary rehabilitation can restore meaningful functional capacity even when the underlying structural deformity cannot be fully corrected.