Long-term follow-up results of 550 cases of spastic torticollis treated with modified Foerster-Dandy operation

Abstract

Objective To investigate the long-term efficacy and complications of modified Foerster-Dandy operation in the treatment of spasmodic torticollis (ST). Methods A total of 550 cases of ST admitted to Neurosurgery Department of China-Japan Friendship Hospital from April 2005 to April 2013 were retrospectively enrolled into this study. All patients were treated with modified Foerster-Dandy operation, in which occipitocervical posterior median approach was used without opening of occipital squama and foramen magnum. Limited laminectomy, endoscope-assisted bilateral subdural accessory nerve and C1 spinal nerve root cutting and selective partial cutting of anterior and posterior roots of C2-4 spinal nerve were conducted. The international Tsui scale was used to evaluate the efficacy post operation. We also analyzed the complications occurring following the operations. Results All patients were followed up for 60-156 months, with an average of 117.0±5.5 months. The median improvement rate of spasticity at 6 months, 12 months and the latest follow-up was 73.6% (54.7%, 86.4%), 70.2% (48.8%, 85.1%) and 73.2% (51.1%, 88.5%), respectively. The Tsui score before operation was 17.2 (13.6, 20.6). However, at 6 months, 12 months and the latest follow-up, the Tsui scores were 4.6 (2.2, 7.3), 4.9 (2.6, 8.1) and 4.3 (2.0, 7.5), respectively, which were significantly lower than those prior to operation (all P<0.05). However, 30 (5.5%) cases had neck rotation weakness, 34 (6.2%) reported shoulder shrug weakness, 32 (5.8%) had limited arms abduction, 45 (8.2%) developed long-term neck back pain and numbness, 11 (2.0%) reported neck circumference narrowing, and 62 (11.3%) suffered from dysphagia. Among them, no obvious improvement was achieved in 5 cases with neck rotation weakness and 9 cases with dysphagia. All the other complications were relieved to various degrees during the follow-up period after rehabilitation training. During the follow-up, spasm recurrence to various degrees was reported in 25 (4.5%) cases. Conclusion Modified Foerster-Dandy operation is a safe and effective surgical therapy for patients with ST. Key words: Spasmodic torticollis; Neurosurgical procedures; Treatment outcome; Postoperative complications; Foerster-Dandy operation