Selective Peripheral Denervation for Spasmodic Torticollis |
Ji Young Moon, In Bo Han, Ryoong Huh, Sang Sup Chung |
Department of Neurosurgery, Bundang CHA Hospital, College of Medicine, Pochon CHA University, Seongnam, Korea |
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Abstract |
Objective The purpose of this study is to establish the effectiveness of the Bertrand operation of the spasmodic torticollis. Accurate diagnosis and classification of spasmodic torticollis were related with the appropriate treatment and prognostic information.
It is important that physical examination of palpation of hypertrophied muscles and dynamic electromyography. Brain imaging
study is not routinely required for a accurate diagnosis and classification. Psychiatric evaluation is required for accurate diagnosis.
Patients and Methods: The analysis was performed to the patients received selective peripheral denervation with the diagnosis
of spasmodic torticollis from October 1997 to July 2006. The mean age 40.8 years and the ratio of male vs. female, 1:0.71. The
mean symptom duration was 35.7 months and no difference was found in the laterality with the ration of right vs. left, 1:1. There
were 5 rotational type spasmodic torticollis patients and the rest were combined type (3 rotation plus retrocollis, 4 rotation plus
laterocollis). 12 patients underwent the traditional Bertrand procedure. Intensive rehabilitation for antagoniset muscle strengthening were performed from 5 to 7 days after operation.
Results The surgical results were divided into four groups labeled“excellent”,“good”,“fair”, and“poor”. 5 cases were belonged to resulted in excellent, 6 cases in good, one case in fair. No patient was belonged to poor. There was no significant surgical complication. The complications including the occipital neuralgia, wound infection, shoulder drop, delirium, and general
weakness were recovered.
Conclusion It is important that the type of spasmodic torticollis at the preoperative period is classified. When the botulinum
toxin therapy would be failed, selective peripheral denervation for the treatment of spasmodic torticollis is a useful and safe surgical technique. |
Key Words:
Spasmodic torticollis, Peripheral denervation, Rhizotomy. |
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