Abstract
Anterocollis (AC) is caused by dystonia of superficial and deep cervical muscles. Bilateral contraction of sternocleidomastoid muscles (SCM) normally leads to head retroflexion and chin protraction, but in dystonic anterior shift it leads to head anteversion. Independently, longus colli muscles (LGC) mediate cervicospinal anteflexion and head anteversion. Thus, CT-guided BoNT-A injection of the often hypertrophic LGC is proposed in AC without anterior shift. We report on 10 treatments of LGC in 7 pts. with AC as the main symptom of cervical dystonia. 3 pts. displayed anterior shift, 1 pt. posterior shift, 3 pts. no shift. TWSTRS and chin-brow vertical angle (CBVA) were assessed. Cervical CT showed asymmetric hypertrophy of LGC in pts. without shift but not in pts. with anterior shift. In the latter, bilateral treatment of SCM and anterior scalene muscles improved dystonia. In pts. without shift, treatment of superficial cervical muscles did not sufficiently improve AC, while TC responded well. In these pts., CT-guided injection of the hypertrophic LGC reduced the TWSTRS-subscore for AC by 42% and CBVA by 50%. This improvement of AC lasted longer than with treatment of superficial cervical muscles alone (up to 9 months). By contrast, in a pt. with posterior shift, LGC treatment did not prove beneficial to AC. In AC with anterior shift, SCM should be treated bilaterally, but in AC without anterior shift CT-guided BoNT-A injection of the hypertrophic LGC is strongly recommendable.
Published Version
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