Effectiveness of Surgical Release in Patients With Neglected Congenital Muscular Torticollis According to Age at the Time of Surgery

Abstract

ObjectiveTo identify the correlation between change in spinal deformities after surgical release and age at the time of surgery, and the effectiveness of surgical release in patients with neglected congenital muscular torticollis (CMT).MethodsThis was a retrospective study of 46 subjects with neglected CMT who had undergone surgical release at age ≥5 years at a tertiary medical center between January 2009 and January 2014. Spinal deformities were measured on anteroposterior plain radiographs of the cervical and whole spine, both preoperatively and postoperatively, to assess 3 parameters: cervicomandibular angle (CMA), lateral shift (LS), and Cobb angle (CA). We analyzed the change in spinal deformities after surgical release in consideration of age at the time of surgery.ResultsThe median age at the time of surgery was 12.87 years. All 3 parameters showed significant improvement after surgical release (median values, pre- to post-surgery: CMA, 12.13° to 4.02°; LS, 18.13 mm to 13.55 mm; CA, 6.10° to 4.80°; all p<0.05). There was no significant correlation between age at the time of surgery and change in CMA (R=0.145, p=0.341) and LS (R=0.103, p=0.608). However, CA showed significant improvement with increasing age (R=0.150, p=0.046).ConclusionWe assessed the correlation between change in spinal deformities after surgical release and age at the time of surgery. We found that that surgical release is effective for spinal deformities, even in older patients. These findings enhance our understanding of the effectiveness and timing of surgical release in patients with neglected CMT.

Experience with the Management of 2599 Cases of Congenital Muscular Torticollis and a Multicenter Epidemiological Investigation in 17 Hospitals in China

“…CMT reportedly heals with age [5,9,10,13]. Nevertheless, early treatment methods remain controversial.…”

“…However, the sooner children with CMT receive standardized treatment, the better their prognosis will become [19]. Physiotherapy remains the rst choice and most commonly applied treatment [5,7,9]. From 2004 to 2020, 2599 children with CMT were treated at our hospital with physiotherapy combined with local injection of SCM drugs and SCM release surgery in the three-step standardized treatment plan (Fig.…”

“…Congenital muscular torticollis (CMT) is caused by brosis on one side of the sternocleidomastoid muscle (SCM) as well as skeletal muscle contracture, resulting in limited head and neck movements, head and neck deviation, and abnormal posture [1][2][3]. Without timely diagnosis and treatment, CMT can lead to facial asymmetry and spinal deformity [4][5][6]. The incidence of CMT ranges from < 1-3.9% [7][8][9].…”

Reversal of Degenerative Changes in Cervical Spine Following Bipolar Release in a Neglected Case of Congenital Muscular Torticollis: A Case Report

“…Best outcomes are obtained between 1 to 4 years of age group. After 5 years of age, the efficacy of surgery is reduced due to irreversible craniofacial deformity [7][8][9].…”

A rare case of 9 years congenital muscular torticollis treated with complete unipolar sternocleidomastoid release: A case report and literature review

“…Congenital muscular torticollis (CMT) is defined as a thickening and/or tightness of the unilateral sternocleidomastoid muscle (SCM) characterized by fibrosis, resulting in a shortening of the SCM and consequent limited neck motion [1] . When left untreated, CMT may result in progressive limitation of head movement which may end up in eye movement disorder, craniofacial asymmetry, neck pain and compensatory asymmetrical spine curvature that worsens with age.…”