Pattern of premature degenerative changes of the cervical spine in patients with spasmodic torticollis and the impact on the outcome of selective peripheral denervation

Abstract

Objectives-To characterise the pattern of and risk factors for degenerative changes of the cervical spine in patients with spasmodic torticollis and to assess whether these changes aVect outcome after selective peripheral denervation. Methods-Preoperative CT of the upper cervical spine of 34 patients with spasmodic torticollis referred for surgery were reviewed by two radiologists blinded to the clinical findings. Degenerative changes were assessed for each joint separately and rated as absent, minimal, moderate, or severe. Patients were clinically assessed before surgery and 3 months postoperatively by an independent examiner using standardised clinical rating scales. For comparison of means a t test was carried out. To determine whether an association exists between the side of degenerative changes and type of spasmodic torticollis a 2 test was used. Changes in severity, disability, and pain before and after surgery were calculated using a Wilcoxon matched pairs signed ranks test. Results-Fourteen out of 34 patients had moderate or severe degenerative changes. They were predominantly found at the C2/C3 and C3/C4 level and were significantly more likely to occur on the side of the main direction of the spasmodic torticollis (p=0.015). There was no significant diVerence in age, sex, duration of torticollis, overall severity, degree of disability, or pain between the group with either no or minimal changes and the group with moderate or severe changes. However, in the second group the duration of inadequate treatment was longer (10.1 v 4.8 years; p=0.009), head mobility was more restricted (p=0.015), and head tremor was more severe (p=0.01). At 3 months postoperatively, patients with no or minimal degenerative changes showed a significant improvement in pain and severity whereas no diVerence was found in those with moderate or severe changes. Conclusions-Patients with spasmodic torticollis have an increased risk of developing premature degenerative changes of the upper cervical spine that tend to be on the side towards which the head is turned or tilted and compromise outcome after surgery. EVective early treatment of spasmodic torticollis with botulinum toxin seems to have a protective eVect. Patients with spasmodic torticollis and restricted head mobility who do not adequately respond to treatment should undergo imaging of the upper cervical spine. Patients with imaging evidence of moderate or severe degenerative changes seem to respond poorly to selective peripheral denervation. (J Neurol Neurosurg Psychiatry 2000;68:465-471)

Pallidal deep brain stimulation in patients with cervical dystonia and severe cervical dyskinesias with cervical myelopathy

“…17 Many of these patients are referred only late when they are already wheelchair bound or when they have developed other severe neurological deficits. Also, they are often not considered candidates for spinal surgery because it is assumed that only minor benefit is achieved and the risk of surgical complications and spinal instability is higher than in other patients.…”

“…[15][16][17][18][19][20][21] Serial selective procedures tailored to the individual pattern of dystonic activity can achieve varying long term benefit with low permanent morbidity. 22 Peripheral surgery, however, is not suited in a subset of patients with complex CD.…”

Dystonia and Peripheral Nerve Surgery in the Cervical Area

“…Cervicalgia and headache sometimes occur in patients suffering from the disease (Albanese, 2005;Brashear, 2004, Schim, 2006. A critical long-term sequelae of th is k ind of mo vement disord er is premature cervica l spi nal deg enerative disease (Chawda et al, 2000) which possibly progresses to cervical spondylotic myelopathy (Hagenah et al, 2001;Jameson et al, 2010;Konrad et al, 2004;Krauss et al, 2002;Spitz et al, 2006;Tonomura et al, 2007;Waterston et al, 1989).…”

Compensatory head posture and neck problems: is there an association? A cohort study of nystagmus patients

“…4,5 Many patients have a limited range of neck motion. 4 Up to a third develop premature spondylosis 6,7 with accompanying radiculopathy and rarely myelopathy. Computerised tomography and magnetic resonance imaging show typical changes of spondylosis with loss of disc height, vertebral sclerosis, and osteophyte formation.…”

“…Computerised tomography and magnetic resonance imaging show typical changes of spondylosis with loss of disc height, vertebral sclerosis, and osteophyte formation. 6 Disability is common and may have a major effect on quality of life. 8 As patients with both cervical dystonia and congenital nystagmus can have abnormal head posture, we hypothesised that compensatory head posture due to nystagmus can be associated with neck problems.…”