Torticollis in childhood-a practical guide for initial assessment

Evaluation and application of a Chinese version symptom questionnaire for visual dysfunctions (CSQVD) in school-age children

Objective

To develop and evaluate a Chinese version of the Symptom Questionnaire for Visual Dysfunctions (CSQVD) to quantify visual dysfunction symptoms in school-age children with various eye diseases, and to explore the relationship between ophthalmological disorders and visual dysfunction symptoms.

Methods

Following standard scale adaptation procedures, the Symptom Questionnaire for Visual Dysfunctions (SQVD) was translated into Chinese (CSQVD). We employed random sampling to survey 198 outpatients aged 7-18 to assess the psychometric properties of the CSQVD. Using the reliable and validated questionnaire, we evaluated the determinants of visual dysfunction symptoms among 406 school-age patients at an eye center. The CSQVD scores were correlated with demographic and clinical variables, including gender, age, eye position, refractive power, and best-corrected visual acuity. Univariate analysis identified potential risk factors, followed by binary logistic regression and multiple linear regression analysis on factors with a P-value <0.05.

Results

The CSQVD scale's critical ratio (CR) values ranged from 6.028 to 10.604. The Cronbach's Alpha coefficient was 0.779, and Spearman-Brown split-half reliability was also 0.779. The I-CVI varied from 0.83 to 1.000, the S-CVI/Ave was 0.857, and the KMO value was 0.821. Multifactorial regression analysis indicated that high myopia (OR ​= ​5.744, 95% CI [1.632, 20.218], P ​= ​0.006) and amblyopia (OR ​= ​9.302, 95% CI [1.878, 46.058], P ​= ​0.006) were significant predictors of CSQVD symptoms. Multiple linear regression analysis showed that BCVA of amblyopic eyes (B ​= ​-5.052, 95% CI [-7.779, 2.325], P ​= ​0.000) and SE power (B ​= ​-0.234, 95% CI [-0.375, 0.205], P ​= ​0.001) significantly affected the CSQVD scale scores.

Conclusions

The Chinese version of the SQVD scale (CSQVD) demonstrates good feasibility, discriminatory power, validity, and reliability in assessing Chinese school-aged children. Furthermore, those who have severe myopia and amblyopia reported more visual dysfunction symptoms.

Disease spectrum of torticollis in children and diagnostic flowchart: A retrospective, single-centre study

AIM

To describe the disease spectrum of torticollis in Chinese children and to improve its diagnostic flowchart.

METHODS

A retrospective analysis was conducted at the Rehabilitation Department of Beijing Children's Hospital from 2017 to 2021. Patients were diagnosed and referred based on a diagnostic flowchart of torticollis. Detailed patient data were collected from the outpatient electronic medical record system.

RESULTS

A total of 2047 patients met the inclusion criteria. The top five conditions were congenital muscular torticollis (CMT) (76.6%), cerebral palsy (5.1%), ocular torticollis (4.7%), brachial plexus injury (1.9%) and atlantoaxial rotary subluxation (1.3%). CMT was most common in 0-2 year olds, cerebral palsy in 3-5 year olds, and atlantoaxial rotary subluxation in 7-12 year olds. The top five referral departments were orthopaedics, ophthalmology, otolaryngology, head and neck surgery, neurology and neurosurgery.

CONCLUSIONS

The disease spectrum of torticollis in children and the diagnostic flowchart provide important references for diagnosing torticollis, which necessitates multidisciplinary collaboration.

Pediatric torticollis: clinical report and predictors of urgency of 1409 cases

BACKGROUND

To date, the etiology and risk factors of torticollis are still poorly defined in the pediatric literature. Especially in the Emergency Department (ED) scenario, it is critical to reliably distinguish benign and transient conditions from (potentially) life-threatening disorders. This study describes the clinical characteristics of a large sample of children with torticollis. The aim of our study was to detect epidemiology, etiology and predictive variables associated with a higher risk of life-threatening conditions in acute torticollis.

METHODS

We conducted a pediatric retrospective study of acute torticollis over a 13-year period referred to the ED of a tertiary pediatric Hospital. We reported the characteristics in the overall sample and in two subgroups divided according to urgency of the underlying condition. Furthermore, we developed a multivariate model aimed at identifying the main clinical predictors of the need for urgent care.

RESULTS

1409 patients were analyzed (median age 5.7 years, IQR 5.8). A history of trauma was present in 393 patients (27.9%). The symptom most frequently associated with torticollis were pain (83.5%). At least one pathological finding was found in 5.4 to 7.9% of patients undergoing further imaging. Hospitalization was required in 11.1% of cases (median duration 4 days). The most frequent etiologies of torticollis were postural cause (43.1%), traumatic (29.5%), and infective/inflammatory (19.1%). A longer time from onset of torticollis and the presence of headache or vomiting were strongly correlated with an underlying urgent condition, after adjusting for the other clinically and statistically significant variables in the bivariate analysis.

CONCLUSION

Our study shows that an urgent condition most commonly occur in patients presenting with history of trauma or headache, vomiting and torticollis for more than 24 h should undergo further diagnostic evaluation and short-term follow-up, restricting invasive or expensive investigations to patients with clinical suspicion of an underlying harmful condition.

Torticollis in Non-Syndromic Unicoronal Craniosynostosis Is Predominantly Ocular Related

(1) Background: Patients with unicoronal craniosynostosis (UCS) often show torticollis which can result from either an ocular cause or contraction of the sternocleidomastoid muscle. For clinicians, it is crucial to know the prevalence of ocular torticollis (OT) to ensure appropriate referral for treatment. Furthermore, associated ophthalmic features with OT in these patients are scarcely described. The aim of this study was to determine the prevalence of OT in non-syndromic UCS patients and investigate its associated ophthalmic features. (2) Methods: In this descriptive cross-sectional study medical records of non-syndromic UCS patients treated between 1994-2022 in one tertiary care hospital in The Netherlands were retrospectively reviewed. Collected data included: diagnosis and type of torticollis, binocular single vision (BSV), strabismus, ocular motility, alphabetical patterns, refractive error, and amblyopia. Patients were classified as OT, based on their ophthalmic and/or orthoptic diagnosis. Prevalence was determined with the 95% CI using the Clopper-Pearson exact test. Associations between OT and the ophthalmic features were determined using Chi-square or Fishers' exact test and its effect size was calculated using Cramer's V. (3) Results: In total, 146 patients were included, of whom 57 had torticollis. An ocular cause for the torticollis was found in 54 patients. The prevalence of OT was 37% (n = 146; 95% CI [0.292-0.454]). Significant associations were found between OT and strabismus (p < 0.001), ocular motility abnormalities (p < 0.001), alphabetical patterns (p < 0.001), and amblyopia (p = 0.002). BSV (p = 0.277) and refractive error (p = 1.0) were not significantly associated with OT. However, in OT the BSV was relatively poor (42.1%) and more frequently absent (26.3%) compared to the non-torticollis group (7% poor and 16.3% absent). In both groups, excyclotorsion was predominantly present (62.3%). (4) Conclusions: In 95% of cases, torticollis in UCS patients is ocular-related. Overall, one in three patients with UCS have OT. This study emphasizes the importance of a timely referral of all patients with UCS with torticollis to an orthoptist and/or ophthalmologist, specialized in diagnosing and treatment of OT, before considering physiotherapy.

Posterior Surgery in the Treatment of Craniovertebral Junction Deformity with Torticollis

OBJECTIVE

To investigate the clinical effect of posterior surgery in the treatment of craniovertebral junction (CVJ) deformities with torticollis and methods for preventing and treating complications in order to obtain a reasonable treatment strategy.

METHODS

From January 2007 to December 2017, 78 patients who suffered from CVJ deformities with torticollis treated by posterior surgery were analyzed. The surgical techniques were all posterior correction and fusion to restore the anatomical alignment of the craniovertebral junction. The visual analog score (VAS) and Short Form-36 (SF-36) health survey questionnaire were utilized to evaluate preoperative and postoperative neck pain, and changes in the torticollis angle and atlas-dens interval (ADI) were evaluated through anteroposterior X-ray and computed tomography. Intra- and postoperative complications were all recorded. One-way ANOVA, LSD-t test, and χ² test were performed to evaluate the difference between the preoperative and postoperative data.

RESULTS

The mean follow-up time was 37.4 ± 15.7 months, the average operation time was 115.6 ± 12.8 min, and the average blood loss was 170.8 ± 26.3 mL. According to the deformity site, the range of posterior correction and fusion was as follows: 38 cases of C₁ -C₂ , 33 cases of C₀ -C₂ , and seven cases of C₀ -C₃ . The preoperative SF-36, VAS, torticollis angle, and ADI were 42.6 ± 8.8, 4.8 ± 1.1, 37.2 ± 11.2°, and 4.9 ± 2.3 mm, respectively. The difference was significant at 3 months post operation (p < 0.05), and there was no significant difference at the final follow-up compared with 3 months post operation (p > 0.05).

CONCLUSION

It can objectively achieve favorable correction and satisfactory clinical effects under posterior correction and fixation for CVJ deformities with torticollis. Intra- and postoperative complications can be settled by proper management.

An Unusual Case of Torticollis: Split Cord Malformation with Vertebral Fusion Anomaly: A Case Report and a Review of the Literature

We describe the exceptional case of spinal cord malformation, associating neurenteric cyst, and cervical vertebral malformation, initially presenting as torticollis. A 4-month-old child presented with torticollis to the right since birth. A cervical spine X-ray revealed suspicious findings of fusion anomaly, and a cervical spine CT showed extensive segmentation-fusion anomaly with an anterior and posterior bony defect in the C1–6 vertebrae. A cervical spine MRI revealed extensive segmentation-fusion anomaly with an anterior bony defect, and the spinal cord split forward and backward at the C3 level, showing two hemicords. The anterior half of the hemicord and dural sac extended to the right inferior side, towards the upper blind end of esophageal duplication, and the posterior half joined the hemicord at the back and C6 level. After multidisciplinary collaboration, follow-up and conservative treatment were planned. At 12 months, he had developmental delay, and torticollis showed little improvement. No neurological abnormalities have been observed. The patient plans to undergo surgery for the cervical spine fusion anomaly. Cervical spine X-rays should always be performed when assessing a patient with torticollis to rule out cervical vertebral segmentation anomalies, despite the rarity of the condition.