Current Considerations for the Management of Cervical Dystonia

Jabbari, Bahman

doi:10.17925/usn.2008.04.01.37

Cited by 1 publication

(1 citation statement)

References 22 publications

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“…Hyper-active muscles do not synchronize their activity with head and neck movement and are out of voluntary control. The head and neck may be simply rotated (torticollis), tilted (laterocollis), retroflexed (retrocollis) or anteflexed (antecollisis), but deviations my combine [2][3][4].…”

Section: Introductionmentioning

confidence: 99%

A Microvascular Decompression Coupled to an Unilateral Intradural Rhizotomy for Cervical Dystonia (Spasmodic Torticollis) Results On 30 Patients

2021

J Surg

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Background: Surgery remains an effective option to treat Cervical Distonia or Torticollis despite the advance of conservative treatments. Neurologists favor Deep Brain Stimulation (DBS), on the assumption that there is a basal ganglia dysfunction. However, traditionally torticollis has been treated with Sternocleidomastoid Muscle (SCM) denervation intervening on the 11 th nerve either intradurally or at the entrance into the SCM muscle fibers. Furthermore, there is well-documented literature on 11 th nerve vascular conflict as a cause of torticollis. In our 30 cases, we resolved a vascular conflict with the 11 th nerve and severed its C1-C2 rootlets to denervate the SCM and obtain an immediate release of its pathologic spasm and contraction. We exposed the upper cervical spinal cord and the 11 th nerve with a novel minimally invasive unilateral approach.Methods: We retrospectively evaluate 30 patients operated for CD. They had a unilateral compromise of SCM muscle which resulted from EMG and MRI studies, compatible with a vascular conflict. These patients underwent a C1-C2 hemilaminectomy, with a unilateral enlargement of the occipital rim. We disregarded the complexity and pattern of head deviation. We theorized a conflict between the 11th nerve and the vertebral artery or PICA. In some of them, we could identify such anomalies on preoperative MRI.Results: A conflicting artery was found in all cases. It was the vertebral artery in 27 cases, the PICA in 2 and anterior spinal artery in 1. Overall a positive outcome (head realignment with a preserved range of motion without a need of further medication) was obtained in 23 patients (76,6%). Abolishing abnormal activity in the affected SCM corrected complex patterns of head deviation and lead to an improvement of 85% as measured on the Toronto Western Spasmodic Torticollis Rating Scale (TWSTRS). Conclusion:A reduced unilateral approach focusing on the 11 th nerve rootlets that innervate the abnormal SCM and resolving the underlying vascular conflict is an effective and acceptable way to treat a subgroup of CD.

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Section: Introductionmentioning

confidence: 99%

A Microvascular Decompression Coupled to an Unilateral Intradural Rhizotomy for Cervical Dystonia (Spasmodic Torticollis) Results On 30 Patients

2021

J Surg

View full text Add to dashboard Cite

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Current Considerations for the Management of Cervical Dystonia

Cited by 1 publication

References 22 publications

A Microvascular Decompression Coupled to an Unilateral Intradural Rhizotomy for Cervical Dystonia (Spasmodic Torticollis) Results On 30 Patients

A Microvascular Decompression Coupled to an Unilateral Intradural Rhizotomy for Cervical Dystonia (Spasmodic Torticollis) Results On 30 Patients

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