Torticollis Caused by Nontraumatic Craniovertebral Junction Abnormalities

Park, Sunghoon; Woo, Ji-Eun; Kim, Sang-Hyun; Yim, Shin-Young

doi:10.1097/scs.0000000000004441

Cited by 4 publications

(7 citation statements)

References 24 publications

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“…Our results reflect those of several previous studies, which raise clinicians’ awareness of vertebral anomaly as a cause of torticollis. In particular, the studies support the fact that, although patients have vertebral anomalies, the only symptom can be torticollis [ 3 , 4 , 24 , 25 , 26 ]. If patients with congenital vertebral anomaly have no symptoms that must be resolved for daily life, such as pain, they do not need overtreatment [ 27 , 28 ].…”

Section: Discussionmentioning

confidence: 61%

“…The abnormal posture of the head and neck refers to torticollis and is often encountered in the pediatric clinic. Congenital muscular torticollis (CMT) is the most common cause of torticollis in children [ 3 ]. Therefore, although congenital torticollis can be caused by congenital structural abnormalities of the vertebrae, it can be misdiagnosed as CMT on the first clinic visit.…”

Section: Introductionmentioning

confidence: 99%

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Congenital Osseous Torticollis that Mimics Congenital Muscular Torticollis: A Retrospective Observational Study

et al. 2020

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It may be difficult to diagnose congenital osseous torticollis based on physical examinations or plain X-rays, especially when children have no other accompanying congenital defects. This study reports the children with torticollis caused by the vertebral anomaly with the symptom of abnormal head and neck posture only. We retrospectively reviewed the records of 1015 patients diagnosed with congenital torticollis in a single tertiary hospital (Incheon St. Mary’s Hospital, Korea) who were referred from a primary local clinic. We included those with deficits in passive range of motion (PROM) of neck. Ultrasonography of the sternocleidomastoid (SCM) muscles, ophthalmologic and neurologic examinations, and cervical X-rays were performed for all patients. If bony malalignment was suspected from X-ray, three-dimensional volume-rendered computed tomography (3D-CT) was performed. Ten patients were diagnosed with osseous torticollis with no defect other than bony anomalies. Although X-ray images were acquired for all patients, vertebral anomalies were definitely confirmed in three cases (30.0%) only, and the others (70.0%) were confirmed by CT. The most common type of vertebral anomaly was single-level fusion. Identifying congenital vertebral anomalies is challenging especially when the degree of invasion is only one level. Although abnormal findings on X-rays may be subtle, a careful examination must be performed to avoid misdiagnosis.

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Section: Discussionmentioning

confidence: 61%

Section: Introductionmentioning

confidence: 99%

Congenital Osseous Torticollis that Mimics Congenital Muscular Torticollis: A Retrospective Observational Study

et al. 2020

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“…In more advanced cases, examination signs can include severely restricted rotation and lateral flexion of the cervical spine to the affected side, 65 crepitus, prominent tenderness at the occipito–cervical junction, craniocervical kyphosis, and torticollis. 66 The presence of gait abnormalities, radicular symptoms, and audiovisual symptoms are unlikely to be related to isolated AO or AA dysfunction.…”

Section: Question 1: Can History and Physical Examination Be Used To Identify Painful Ao Or Aa Joints Or To Select People For Prognostic mentioning

confidence: 99%

Consensus practice guidelines on interventions for cervical spine (facet) joint pain from a multispecialty international working group

Hurley

Adams

Barad

et al. 2021

Reg Anesth Pain Med

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BackgroundThe past two decades have witnessed a surge in the use of cervical spine joint procedures including joint injections, nerve blocks and radiofrequency ablation to treat chronic neck pain, yet many aspects of the procedures remain controversial.MethodsIn August 2020, the American Society of Regional Anesthesia and Pain Medicine and the American Academy of Pain Medicine approved and charged the Cervical Joint Working Group to develop neck pain guidelines. Eighteen stakeholder societies were identified, and formal request-for-participation and member nomination letters were sent to those organizations. Participating entities selected panel members and an ad hoc steering committee selected preliminary questions, which were then revised by the full committee. Each question was assigned to a module composed of 4–5 members, who worked with the Subcommittee Lead and the Committee Chairs on preliminary versions, which were sent to the full committee after revisions. We used a modified Delphi method whereby the questions were sent to the committee en bloc and comments were returned in a non-blinded fashion to the Chairs, who incorporated the comments and sent out revised versions until consensus was reached. Before commencing, it was agreed that a recommendation would be noted with >50% agreement among committee members, but a consensus recommendation would require ≥75% agreement.ResultsTwenty questions were selected, with 100% consensus achieved in committee on 17 topics. Among participating organizations, 14 of 15 that voted approved or supported the guidelines en bloc, with 14 questions being approved with no dissensions or abstentions. Specific questions addressed included the value of clinical presentation and imaging in selecting patients for procedures, whether conservative treatment should be used before injections, whether imaging is necessary for blocks, diagnostic and prognostic value of medial branch blocks and intra-articular joint injections, the effects of sedation and injectate volume on validity, whether facet blocks have therapeutic value, what the ideal cut-off value is for designating a block as positive, how many blocks should be performed before radiofrequency ablation, the orientation of electrodes, whether larger lesions translate into higher success rates, whether stimulation should be used before radiofrequency ablation, how best to mitigate complication risks, if different standards should be applied to clinical practice and trials, and the indications for repeating radiofrequency ablation.ConclusionsCervical medial branch radiofrequency ablation may provide benefit to well-selected individuals, with medial branch blocks being more predictive than intra-articular injections. More stringent selection criteria are likely to improve denervation outcomes, but at the expense of false-negatives (ie, lower overall success rate). Clinical trials should be tailored based on objectives, and selection criteria for some may be more stringent than what is ideal in clinical practice.

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“…Common historical and physical examination findings of AA dysfunction include limited ROM during rotation as well as flexion and extension depending on the extent of tectorial membrane impairment. In more advanced cases, examination signs can include severely restricted rotation and lateral flexion of the cervical spine to the affected side [ 65 ], crepitus, prominent tenderness at the occipito–cervical junction, craniocervical kyphosis, and torticollis [ 66 ]. The presence of gait abnormalities, radicular symptoms, and audiovisual symptoms are unlikely to be related to isolated AO or AA dysfunction.…”

Section: Question 1: Can History and Physical Examination Be Used To Identify Painful Ao Or Aa Joints Or To Select People For Prognostic mentioning

confidence: 99%

Consensus practice guidelines on interventions for cervical spine (facet) joint pain from a multispecialty international working group

et al. 2021

View full text Add to dashboard Cite

Background The past two decades have witnessed a surge in the use of cervical spine joint procedures including joint injections, nerve blocks and radiofrequency ablation to treat chronic neck pain, yet many aspects of the procedures remain controversial. Methods In August 2020, the American Society of Regional Anesthesia and Pain Medicine and the American Academy of Pain Medicine approved and charged the Cervical Joint Working Group to develop neck pain guidelines. Eighteen stakeholder societies were identified, and formal request-for-participation and member nomination letters were sent to those organizations. Participating entities selected panel members and an ad hoc steering committee selected preliminary questions, which were then revised by the full committee. Each question was assigned to a module composed of 4–5 members, who worked with the Subcommittee Lead and the Committee Chairs on preliminary versions, which were sent to the full committee after revisions. We used a modified Delphi method whereby the questions were sent to the committee en bloc and comments were returned in a non-blinded fashion to the Chairs, who incorporated the comments and sent out revised versions until consensus was reached. Before commencing, it was agreed that a recommendation would be noted with >50% agreement among committee members, but a consensus recommendation would require ≥75% agreement. Results Twenty questions were selected, with 100% consensus achieved in committee on 17 topics. Among participating organizations, 14 of 15 that voted approved or supported the guidelines en bloc, with 14 questions being approved with no dissensions or abstentions. Specific questions addressed included the value of clinical presentation and imaging in selecting patients for procedures, whether conservative treatment should be used before injections, whether imaging is necessary for blocks, diagnostic and prognostic value of medial branch blocks and intra-articular joint injections, the effects of sedation and injectate volume on validity, whether facet blocks have therapeutic value, what the ideal cut-off value is for designating a block as positive, how many blocks should be performed before radiofrequency ablation, the orientation of electrodes, whether larger lesions translate into higher success rates, whether stimulation should be used before radiofrequency ablation, how best to mitigate complication risks, if different standards should be applied to clinical practice and trials, and the indications for repeating radiofrequency ablation. Conclusions Cervical medial branch radiofrequency ablation may provide benefit to well-selected individuals, with medial branch blocks being more predictive than intra-articular injections. More stringent selection criteria are likely to improve denervation outcomes, but at the expense of false-negatives (ie, lower overall success rate). Clinical trials should be tailored b...

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Torticollis Caused by Nontraumatic Craniovertebral Junction Abnormalities

Cited by 4 publications

References 24 publications

Congenital Osseous Torticollis that Mimics Congenital Muscular Torticollis: A Retrospective Observational Study

Congenital Osseous Torticollis that Mimics Congenital Muscular Torticollis: A Retrospective Observational Study

Consensus practice guidelines on interventions for cervical spine (facet) joint pain from a multispecialty international working group

Consensus practice guidelines on interventions for cervical spine (facet) joint pain from a multispecialty international working group

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