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Folse M, Diaz R, Peterson R, Toms J. Deep Brain Stimulation Before Anterior Cervical Discectomy and Fusion for a Patient With Cervical Dystonia and Cervical Myelopathy: A Case Report. Cureus 2023; 15:e46221. [PMID: 37905251 PMCID: PMC10613504 DOI: 10.7759/cureus.46221] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 09/29/2023] [Indexed: 11/02/2023] Open
Abstract
Cervical dystonia with concurrent cervical myelopathy is a challenging pathology that requires thoughtful management. A 46-year-old female was referred to our center with this presentation. We elected to perform bilateral globus pallidus internus deep brain stimulation (DBS-GPi) prior to C5 to C7 anterior cervical discectomy and fusion (ACDF) to avoid the potential for dystonic movements to negatively impact cervical fusion. The patient was followed up at three months post C5 to C7 ACDF and nine months post DBS-GPi with complete control of tremor and no radiographic evidence of hardware loosening or malalignment. Though this strategy was successful in treating both our patient's cervical myelopathy and cervical dystonia, larger studies need to be conducted to optimize the treatment of patients presenting with these concurrent pathologies.
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Affiliation(s)
- Michael Folse
- Department of Neurosurgery, Louisiana State University Health Sciences Center, Shreveport, USA
| | - Ryan Diaz
- Department of Neurosurgery, Louisiana State University Health Sciences Center, Shreveport, USA
| | - Racheal Peterson
- Department of Neurosurgery, Louisiana State University Health Sciences Center, Shreveport, USA
| | - Jamie Toms
- Department of Neurosurgery, Louisiana State University Health Sciences Center, Shreveport, USA
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Does alar ligament injury predict conservative treatment failure of atlantoaxial rotatory subluxation in adults: Case report and review of the literature. Spinal Cord Ser Cases 2021; 7:103. [PMID: 34862363 DOI: 10.1038/s41394-021-00464-9] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/12/2021] [Revised: 10/28/2021] [Accepted: 11/02/2021] [Indexed: 11/09/2022] Open
Abstract
INTRODUCTION The alar ligament is an important structure in restraining the rotational movement at the atlantoaxial joint. While bony fractures generally heal, rupture of ligaments may heal poorly in adults and often requires surgical stabilization. Atlantoaxial rotatory subluxation (AARS) is a rare injury in adults, and the prognostic importance of the presence of alar ligament injury with regard to the success of nonoperative management is unknown. CASE PRESENTATION A 28-year-old woman presented after a traumatic Type I AARS without evidence of osseous injury, but MRI demonstrated evidence of unilateral alar ligament disruption. Initial conservative management with closed reduction and maintenance in a rigid cervical collar proved unsuccessful, with worsening pain and failure to maintain reduction. She subsequently underwent open reduction and surgical fixation of C1-C2, resulting in resolution of her pain and maintenance of alignment. DISCUSSION Alar ligament rupture may be a negative prognostic indicator in the success of nonoperative management of type I atlantoaxial rotatory subluxation. Additional study is warranted to better assess whether the status of the alar ligament should be considered an important factor in the management algorithm of type I AARS.
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Natural History, Neuroradiological Workup, and Management Options of Chronic Atlantoaxial Rotatory Fixation Caused by Drug-Induced Cervical Dystonia. Case Rep Orthop 2021; 2021:6683268. [PMID: 33763273 PMCID: PMC7946456 DOI: 10.1155/2021/6683268] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/29/2020] [Accepted: 02/18/2021] [Indexed: 11/17/2022] Open
Abstract
Atlantoaxial rotatory fixation (AARF) resulting from drug-induced cervical dystonia (DICD) represents an extremely rare complication of antipsychotic treatment, requiring a comprehensive assessment of pharmacologic therapy and timely radiologic workup. We report a chronic case of Fielding type I, Pang type I AARF secondary to schizophrenia treatment in a 16-year-old girl, along with a review of the literature on the management challenges posed in this condition. In this scenario, torticollis may just represent the tip of the iceberg, and only an effective multidisciplinary approach increases the chances of satisfactory correction with closed reduction, hence avoiding the burden of more invasive treatment options.
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Cervical Myeloradiculopathy and Atlantoaxial Instability in Cervical Dystonia. World Neurosurg 2020; 146:e1287-e1292. [PMID: 33285336 DOI: 10.1016/j.wneu.2020.11.153] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/07/2020] [Revised: 11/25/2020] [Accepted: 11/26/2020] [Indexed: 11/21/2022]
Abstract
OBJECTIVE Atlantoaxial instability, although rarely reported in the literature, can be associated with cervical dystonia (CD) and may lead to compression of the cord at the craniovertebral junction. We present a case series of 4 patients of longstanding CD with neurologic complications. Treatment strategies and challenges are discussed. METHODS Retrospective analysis of 4 cases of longstanding CD with complications of myelopathy or radiculopathy. RESULTS The average age at onset of complications was 28 years (range, 17-37). The average duration of CD was 23.75 years. Narrowing of the craniovertebral junction was seen in 3 patients, of which 2 had os odontoideum, and 1 had rotational malalignment at the atlantoaxial joint. One patient had disc desiccation with bulge and intramedullary signal changes in the cord at C3-4 level. Medical treatment was not satisfactory, but botulinum toxin was partly useful in all. One patient had sequelae of myelopathy and did recover partially after deep brain stimulation. Of the 2 patients who underwent surgical fixation with a fusion of the spine, one improved, and the other had no improvement due to irreversible cord damage. The overall outcome was satisfactory only in 2 patients. CONCLUSIONS Early-onset CD can lead to cord complications at a young age and at higher levels of the cervical spine and at the cervicovertebral junction. Comprehensive management by a multidisciplinary team is crucial to prevent complications early.
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Singla R, Manjunath N, Sharma R, Mishra S. Neglected Traumatic Atlantoaxial Rotatory Dislocation in Adult: A Case Report. Int J Spine Surg 2020; 14:46-52. [PMID: 32128302 DOI: 10.14444/7006] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
Atlantoaxial rotatory dislocations (AARDs) are common in the pediatric population and rarely seen in adults. We describe a case of neglected AARD and subsequent management. A 25-year-old man developed a Fielding type 1 AARD following a road traffic accident. He was managed conservatively for 1.5 months before being referred to us. The patient underwent surgery 1.5 months after the accident. Closed reduction failed and C1-2 fixation with the Harms technique was performed after intraoperative reduction resulting in correction of deformity. Delay of treatment makes intraoperative reduction more difficult and increases the possibility of the chronic permanent change of neck muscles and ligaments. Hence, a high index of suspicion with a thorough clinical examination and judicious use of radiological investigations is paramount to the appropriate management of such cases.
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Affiliation(s)
- Raghav Singla
- Department of Neurosurgery, All India Institute of Medical Sciences, New Delhi
| | - Niveditha Manjunath
- Department of Neurosurgery, All India Institute of Medical Sciences, New Delhi
| | - Ravi Sharma
- Department of Neurosurgery, All India Institute of Medical Sciences, New Delhi
| | - Shashwat Mishra
- Department of Neurosurgery, All India Institute of Medical Sciences, New Delhi
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Raghav S, Niveditha M, Ravi S, Shashwat M. Neglected Traumatic Atlantoaxial Rotatory Dislocation in Adult. Int J Spine Surg 2020; 13:531-535. [PMID: 31970048 DOI: 10.14444/6071] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
Atlantoaxial rotatory dislocations (AARD) are common in the pediatric population and rarely seen in adults. We describe a case of neglected AARD and subsequent management. A 25-year-old man developed a Fielding type 1 AARD following a road traffic accident. He was managed conservatively for 1.5 months before being referred to us. The patient underwent surgery 1.5 months after the accident. Closed reduction failed, and C1-2 fixation with the Harms technique was performed after intraoperative reduction, resulting in correction of deformity. Delay of treatment makes intraoperative reduction more difficult and increases the possibility of the chronic permanent change of neck muscles and ligaments. Hence, a high index of suspicion with a thorough clinical examination and judicious use of radiological investigations is paramount to the appropriate management of such cases.
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Affiliation(s)
- Singla Raghav
- Department of Neurosurgery, All India Institute of Medical Sciences, New Delhi, India
| | - Manjunath Niveditha
- Department of Neurosurgery, All India Institute of Medical Sciences, New Delhi, India
| | - Sharma Ravi
- Department of Neurosurgery, All India Institute of Medical Sciences, New Delhi, India
| | - Mishra Shashwat
- Department of Neurosurgery, All India Institute of Medical Sciences, New Delhi, India
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Lefaucheur R, Derrey S, Fetter D, Wallon D, Gilard V, Maltête D. Non-traumatic cervical C1-C2 subluxation. Joint Bone Spine 2014; 81:545-6. [PMID: 24703623 DOI: 10.1016/j.jbspin.2014.02.010] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/04/2014] [Accepted: 02/20/2014] [Indexed: 11/26/2022]
Affiliation(s)
- Romain Lefaucheur
- Department of Neurology, Rouen University Hospital, University of Rouen, Rouen, France.
| | - Stéphane Derrey
- Department of Neurosurgery, Rouen University Hosiptal, University of Rouen, Rouen, France
| | - Damien Fetter
- Department of Neurology, Rouen University Hospital, University of Rouen, Rouen, France
| | - David Wallon
- Department of Neurology, Rouen University Hospital, University of Rouen, Rouen, France
| | - Vianney Gilard
- Department of Neurosurgery, Rouen University Hosiptal, University of Rouen, Rouen, France
| | - David Maltête
- Department of Neurology, Rouen University Hospital, University of Rouen, Rouen, France
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Agius S, Breen DP, Haliasos N, Benjamin J, de Silva R. An Ancient Cause of Muscle Spasm…and an Unhelpful Magnetic Resonance Imaging Scan. World Neurosurg 2014; 81:e23-5. [DOI: 10.1016/j.wneu.2011.11.005] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/15/2011] [Accepted: 11/18/2011] [Indexed: 10/15/2022]
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TARANTINO R, DONNARUMMA P, MAROTTA N, MISSORI P, VIOZZI I, LANDI A, DELFINI R. Atlanto axial rotatory dislocation in adults: a rare complication of an epileptic seizure--case report. Neurol Med Chir (Tokyo) 2013; 54:413-6. [PMID: 24201098 PMCID: PMC4533434 DOI: 10.2176/nmc.cr2012-0431] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/14/2012] [Accepted: 03/12/2013] [Indexed: 12/01/2022] Open
Abstract
Atlanto Axial Rotatory Dislocations (AARDs) are a heterogeneous group of post-traumatic pathologies typical of the pediatric age, and rare in adults. We describe the case of a 34-year-old woman, developing Atlanto Axial Rotatory Fixation (AARF) after a generalized tonic-clonic epileptic seizure, an extremely rare traumatic cause never described in literature. AARF was detected only 1 month after the accident and nonsurgical treatment was attempted at the beginning. The patient underwent surgery only 2 months after the accident. The best treatment should be conservative reduction within 1 month; when it is not possible, it is advisable to perform surgery as soon as possible. C1-C2 fixation with Harm's technique is the gold standard for fixed luxations. Delay of treatment makes intraoperative reduction more difficult and increase the establishment of the chronic permanent change of neck muscles and ligaments.
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Affiliation(s)
- Roberto TARANTINO
- Department of Neurosurgery, Sapienza University of Rome, Rome, Italy
| | | | - Nicola MAROTTA
- Department of Neurosurgery, Sapienza University of Rome, Rome, Italy
| | - Paolo MISSORI
- Department of Neurosurgery, Sapienza University of Rome, Rome, Italy
| | - Ilaria VIOZZI
- Department of Neurosurgery, Sapienza University of Rome, Rome, Italy
| | - Alessandro LANDI
- Department of Neurosurgery, Sapienza University of Rome, Rome, Italy
| | - Roberto DELFINI
- Department of Neurosurgery, Sapienza University of Rome, Rome, Italy
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Delnooz CCS, van de Warrenburg BPC. Current and future medical treatment in primary dystonia. Ther Adv Neurol Disord 2012; 5:221-40. [PMID: 22783371 PMCID: PMC3388529 DOI: 10.1177/1756285612447261] [Citation(s) in RCA: 21] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
Abstract
Dystonia is a hyperkinetic movement disorder, characterized by involuntary and sustained contractions of opposing muscles causing twisting movements and abnormal postures. It is often a disabling disorder that has a significant impact on physical and psychosocial wellbeing. The medical therapeutic armamentarium used in practice is quite extensive, but for many of these interventions formal proof of efficacy is lacking. Exceptions are the use of botulinum toxin in patients with cervical dystonia, some forms of cranial dystonia (in particular, blepharospasm) and writer's cramp; deep brain stimulation of the pallidum in generalized and segmental dystonia; and high-dose trihexyphenidyl in young patients with segmental and generalized dystonia. In order to move this field forward, we not only need better trials that examine the effect of current treatment interventions, but also a further understanding of the pathophysiology of dystonia as a first step to design and test new therapies that are targeted at the underlying biologic and neurophysiologic mechanisms.
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Affiliation(s)
- Cathérine C S Delnooz
- Radboud University Nijmegen Medical Centre, Department of Neurology, Donders Institute for Brain, Cognition and Behaviour, Centre for Neuroscience, the Netherlands
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Rubio-Agusti I, Kojovic M, Chandrashekar HS, Edwards MJ, Bhatia KP. Cervical dystonia and joint hypermobility syndrome: A dangerous combination. Mov Disord 2012; 27:203-4. [DOI: 10.1002/mds.24013] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022] Open
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Bronte-Stewart H, Taira T, Valldeoriola F, Merello M, Marks WJ, Albanese A, Bressman S, Moro E. Inclusion and exclusion criteria for DBS in dystonia. Mov Disord 2011; 26 Suppl 1:S5-16. [PMID: 21692112 DOI: 10.1002/mds.23482] [Citation(s) in RCA: 57] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022] Open
Abstract
When considering a patient with dystonia for deep brain stimulation (DBS) surgery several factors need to be considered. Level B evidence has shown that all motor features and associated pain in primary generalized and segmental dystonia are potentially responsive to globus pallidus internus (GPi) DBS. However, improvements in clinical series of ≥ 90% may reflect methods that need improvement, and larger prospective studies are needed to address these factors. Nevertheless, to date the selection criteria for DBS-specifically in terms of patient features (severity and nature of symptoms, age, time of evolution, or any other demographic or disease aspects)--have not been assessed in a systematic fashion. In general, dystonia patients are not considered for DBS unless medical therapies have been previously and extensively tested. The vast majority of reported patients have had DBS surgery when the disease was provoking important disability, with loss of independence and impaired quality of life. There does not appear to be an upper age limit or a minimum age limit, although there are no published data regarding the outcome of GPi DBS for dystonia in children younger than 7 years of age. There is currently no enough evidence to prove that subjects with primary--generalized dystonia who undergo DBS at an early age and sooner rather than later after disease onset may gain more benefit from DBS than those undergoing DBS after the development of fixed skeletal deformities. There is no enough evidence to refuse or support consideration of DBS in patients with previous ablative procedures.
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Affiliation(s)
- Helen Bronte-Stewart
- Department of Neurology and Neurological Sciences, Stanford University, Stanford, California 94305, USA.
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Juneja M, Sharma S, Jain R, Singh D. Atlantoaxial dislocation in a child with generalized primary dystonia. J Clin Neurosci 2011; 18:966-8. [DOI: 10.1016/j.jocn.2010.11.016] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/20/2009] [Revised: 08/07/2010] [Accepted: 11/08/2010] [Indexed: 10/18/2022]
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Jiménez Caballero PE, Ayuga Loro F, Muñoz Escudero F, Lobato Casado P. Mielopatía cervical por pannus reumatoide como forma de la artritis reumatoide. Med Clin (Barc) 2010; 135:432-3. [DOI: 10.1016/j.medcli.2009.06.054] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/06/2009] [Accepted: 06/18/2009] [Indexed: 10/20/2022]
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Tsai SW, Zhong JD, Chen YW, Wu SK, Lin YW. Treatment of upper cervical subluxation in pediatric patients. MANUAL THERAPY 2009; 14:448-451. [PMID: 19201643 DOI: 10.1016/j.math.2009.01.002] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/21/2008] [Revised: 12/31/2008] [Accepted: 01/06/2009] [Indexed: 05/27/2023]
Affiliation(s)
- Sen-Wei Tsai
- Department of Physical Medicine and Rehabilitation, Taichung Veterans General Hospital, No.160, Chungkang Rd., Taichung 407, Taiwan.
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Abstract
Movement disorder emergencies include any movement disorder which evolves over hours to days, in which failure to appropriately diagnose and manage can result in patient morbidity or mortality. It is crucial that doctors recognize these emergencies with accuracy and speed by obtaining the proper history and by being familiar with the phenomenology of frequently encountered movements. These disorders will be discussed based on the most common associated involuntary movement, either parkinsonism, dystonia, chorea, tics or myoclonus, and, when available, review the workup and treatment options based on the current literature.
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