Neurosurgery for spasmodic torticollis(report of 580 cases)

WANG Lu; LI Jun; LIANG Jian; JI Shao-xian; WU Jun

Abstract：Objective To investigate the curative effects of selective peripheral neurotomy and muscle amputation on the spasmodic torticollis (ST). Methods The muscles involved in the spasm were revealed by electromyography (EMG) and CT, or MRI examinations in 580 patients with ST.The muscles related to the spasm were divided into the prime mover which was cut off,synergistic muscles which were denerved and slave muscles which were not treated.The three kinds of surgical methods which were formed were as follows: (1) selective posterior cervical spam muscle resection; (2) selective posterior rhizotomy of cervical nerve 1~6 (C1~6);(3) neurotomy of accessory nerve. The combination of the three methods is called "Triple treatment". The patients with rotatory ST and lateral flexion ST were treated by the triad or bigeminal methods.The patients with retrocollic spasm were bilaterally treated by the first and the second methods.The patients with mixed type ST were treated by selective cervical neurotomy and selective muscle resection. Results The following up for 6~12 months showed that of 565 followed up,429 were cured,68 received good outcomes,52 were on the mend and 16 had unchanged symptoms.The total excellent and good rate was 88.0%.No patients died and the serious complications did not occur in all the patients.Conclusion The selective peripheral neurotomy and muscle amputation are the safe and effective methods to treat ST.