Craniovertebral Junction Abnormalities in Surgical Patients With Congenital Muscular Torticollis

Abstract

Our clinical experience led us to realize that craniovertebral junction (CVJ) abnormalities were common in surgical patients with congenital muscular torticollis (CMT). This study aimed to report the concurrence rate of CVJ abnormalities in surgical patients with CMT, along with comprehensive evaluation of type of concurrent CVJ abnormalities. This was a retrospective cohort study in a tertiary hospital, including 41 subjects who underwent surgical release for CMT at the mean age of 8.38 years. The presence of CVJ abnormalities was analyzed, using craniofacial 3-dimensional computed tomography images. The concurrence rate of CVJ abnormalities was 70% in surgical patients with CMT. Subjects with CVJ abnormalities had, on average, 1.48 abnormalities. The CVJ abnormalities were rotation and lateral shift of the atlanto-axial joint along with rotation of atlanto-occipital joint, where rotation of the atlanto-axial joint was most common (82.76%). There is no patient with anterior shift of the atlanto-axial joint. Chronic mechanical tension by the contracted unilateral sternocleidomastoid muscle of CMT could be responsible for concurrent CVJ abnormalities. The CVJ abnormalities are more common in the atlanto-axial joint than in the atlanto-occipital joint. In conclusions, CVJ abnormality seems to be a common concurrent skeletal complication of CMT, at least, in surgical patients. The CVJ abnormality might be included in the list of skeletal complications of CMT. If CVJ abnormalities are significantly more common in surgical patients with CMT, CVJ abnormalities might be one of predictors of surgical patients with CMT.

Physical Therapy Management of Congenital Muscular Torticollis: A 2018 Evidence-Based Clinical Practice Guideline From the APTA Academy of Pediatric Physical Therapy

“…Up to 18% of cases with asymmetrical head posturing may be due to non-muscular causes, 22 including Klippel-Feil, 22 neurologic disorders, 22,34 ocular disorders, 22,83,90,91 brachial plexus injuries including clavicle fractures, 22 paroxysmal torticollis that alternates sides, 24 spinal abnormalities 87,92 and SCM neoplastic masses 34,85 such as rhabdomyosarcoma. 93 Identification of presentations atypical of CMT, including masses that change shape, location, or size, warrant immediate referral to or consultation with the infant's physician.…”

Ipsilateral Hypertrophy of the Mastoid Process in Surgical Cases of Congenital Muscular Torticollis

“…The CMT group consisted of patients who had met the following 4 criteria: (1) patients who visited the Center for Torticollis, Ajou University Hospital between March 2013 and February 2017; (2) patients who have had surgery for CMT in Ajou University Hospital; (3) patients who had craniofacial CT images taken before surgery for CMT, which provided an adequate view for evaluation of the mastoid process; and (4) patients who were 15 years old or younger. Participants with CMT were managed according to the clinical pathway for CMT described in the previous report (Ahn et al, 2018). Surgery for CMT was determined when both of following surgical criteria for CMT were met: (1) significant resistance and/or limitation of the movement of the head and neck despite adequate physical therapy for 6 months or more and (2) neck MRI displaying 2 or more low-signal intensities and/or 1 large low signal intensity detectable by the naked eye within the involved SCM on T1- and T2-weighted MRI as previously described (Hwang et al, 2012; Kim et al, 2015b; Ahn et al, 2018).…”

“…Participants with CMT were managed according to the clinical pathway for CMT described in the previous report (Ahn et al, 2018). Surgery for CMT was determined when both of following surgical criteria for CMT were met: (1) significant resistance and/or limitation of the movement of the head and neck despite adequate physical therapy for 6 months or more and (2) neck MRI displaying 2 or more low-signal intensities and/or 1 large low signal intensity detectable by the naked eye within the involved SCM on T1- and T2-weighted MRI as previously described (Hwang et al, 2012; Kim et al, 2015b; Ahn et al, 2018).…”

“…A CT scan was indicated in order to investigate concurrent craniovertebral junction abnormalities of surgical cases of CMT, as described in our previous report (Ahn et al, 2018). We identified and measured the mastoid process on the CT scans.…”

Is Longstanding Congenital Muscular Torticollis Provoking Pelvic Malalignment Syndrome?

“…However, previous studies have assumed that congenital trauma, perinatal compartment syndrome, and impairment of the developing SCM owing to intrauterine constraints are the main causes [ 13 ]. Additionally, secondary changes in the infant’s spine have been reported [ 14 , 15 , 16 ]. Recent studies have shown that the severity of spinal deformities in infants with CMT increases with age and with the severity of SCM tightening [ 13 , 14 ].…”