Dystonic Movement Disorders and Spinal Degenerative Disease

Abstract

The occurrence of degenerative spinal disease subsequent to dystonic movement disorders has been neglected and has received more attention only recently. Spinal surgery is challenging with regard to continuous mechanical stress when treatment of the underlying movement disorder is insufficient. To characterize better the particular features of degenerative spinal disease in patients with dystonia and to analyze operative strategies, we reviewed the available published data. Epidemiologic studies reveal that degenerative spinal disorders in patients with dystonia and choreoathetosis occur much earlier than in the physiological aging process. Dystonic movement disorders more often affect the spine at higher cervical levels (C_2–5), in contrast to spinal degeneration with age which manifests more frequently at the middle and lower cervical spine (C_5–7). Degenerative changes of the cervical spine are more likely to occur on the side where the chin is rotated or tilted to. Various operative approaches for treatment of spinal pathologies have been advocated in patients with dystonic movement disorders. The available data do not allow making firm statements regarding the superiority of one approach over the other. Posterior approaches were first used for decompression, but additional anterior fusion became necessary in many instances. Anterior approaches with or without instrumented fusion yielded more favorable results, but drawbacks are pseudarthrosis and adjacent-level disease. Parallel to the development of posterior fusion techniques, circumferential surgery was suggested to provide a maximum degree of cord decompression and a higher fusion rate. Perioperative local injections of botulinum toxin were used initially to enhance patient comfort with halo immobilization, but they are also applied in patients without external fixation nowadays. Treatment algorithms directed at the underlying movement disorder itself, taking advantage of new techniques of functional neurosurgery, combined with spinal surgery have recently been introduced and show promising results.

Retrocollis: Classification, Clinical Phenotype, Treatment Outcomes and Risk Factors

“…Occupation has been traditionally associated with several forms of focal dystonia [19]. Our study also verified the reported association between RC, spinal degenerative disease [20] and spine surgeries (i.e. corpectomy) [21, 22].…”

Deep brain stimulation for dystonia: outcome at long-term follow-up

“…Overall, patients with idiopathic generalized dystonia may achieve improvement which is similar to those who test positive for DYT1 mutation [4]. Since patients with early onset of generalized dystonic movement disorders are at a high risk to develop degenerative spinal disorders, it is important to treat dystonia at an early stage before improvement is [9,15]. The positive results seen in our patient with Meige syndrome have been confirmed meanwhile also by other groups [11,16].…”

Postoperative Cervical Dystonia: Is It an Occult Injury to the Corticospinal Tracts?

“…We read with interest the recent report by Loher et al [1], 'Dystonic Movement Disorders and Spinal Degenerative Disease'. We find the relationship between spinal disorders and dystonia very interesting.…”

“…The patient underwent a posterior fusion with lateral mass screws with significant improvement of his dystonia and total resolution of axial neck pain. We commend Loher et al [1] on their report and would hope that surgeons will begin to evaluate patients preoperatively and postoperatively more closely for these cervical 'tics'. Cervical dystonia, especially in its mild form is likely more common than currently reported and may be a complication that should be discussed preoperatively with patients suffering from spinal cord compression.…”