Ann Rehabil Med.  2016 Feb;40(1):34-42. 10.5535/arm.2016.40.1.34.

Effectiveness of Surgical Release in Patients With Neglected Congenital Muscular Torticollis According to Age at the Time of Surgery

• Min KJ
• Ahn AR
• Park EJ
• Yim SY

• KMID: 2155163
• DOI: http://doi.org/10.5535/arm.2016.40.1.34

Abstract

OBJECTIVE
To identify the correlation between change in spinal deformities after surgical release and age at the time of surgery, and the effectiveness of surgical release in patients with neglected congenital muscular torticollis (CMT).
METHODS
This was a retrospective study of 46 subjects with neglected CMT who had undergone surgical release at age ≥5 years at a tertiary medical center between January 2009 and January 2014. Spinal deformities were measured on anteroposterior plain radiographs of the cervical and whole spine, both preoperatively and postoperatively, to assess 3 parameters: cervicomandibular angle (CMA), lateral shift (LS), and Cobb angle (CA). We analyzed the change in spinal deformities after surgical release in consideration of age at the time of surgery.
RESULTS
The median age at the time of surgery was 12.87 years. All 3 parameters showed significant improvement after surgical release (median values, pre- to post-surgery: CMA, 12.13° to 4.02°; LS, 18.13 mm to 13.55 mm; CA, 6.10° to 4.80°; all p<0.05). There was no significant correlation between age at the time of surgery and change in CMA (R=0.145, p=0.341) and LS (R=0.103, p=0.608). However, CA showed significant improvement with increasing age (R=0.150, p=0.046).
CONCLUSION
We assessed the correlation between change in spinal deformities after surgical release and age at the time of surgery. We found that that surgical release is effective for spinal deformities, even in older patients. These findings enhance our understanding of the effectiveness and timing of surgical release in patients with neglected CMT.

Keyword

Congenital muscular torticollis; Treatment outcome; Surgical procedures

MeSH Terms

Congenital Abnormalities
Humans
Retrospective Studies
Spine
Torticollis*
Treatment Outcome

Figure

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  Fig. 1 The algorithm for subject enrollment from January 2009 to January 2014.

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  Fig. 2 Spinal deformity measurement in terms of CMA, LS, and CA, and change in spinal deformities after surgical release for neglected CMT. (A) Lateral head tilt toward the affected side of CMT. (B) Measurement of CMA to assess lateral head tilt. (C, D) A 20-year-old man who showed significant improvement in CMA after surgical release. (E) Cervical scoliosis with 2 curves occurs toward the affected side of CMT. (F) Measurement of LS to assess cervical scoliosis with 2 curves. (G, H) An 8-year-old girl who showed significant improvement in LS after surgical release. (I) Secondary vertebral scoliosis developed to compensate for abnormal posture of head and neck and/or pelvic elevation. (J) Measurement of CA to assess secondary vertebral scoliosis. (K, L) A 9-year-old girl who showed significant improvement in LS after surgical release. CMA, cervicomandibular angle; LS, lateral shift; CA, Cobb angle; CMT, congenital muscular torticollis.

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  Fig. 3 Effectiveness of surgical release in patients with neglected congenital muscular torticollis. Surgical release resulted in improvements in cervicomandibular angle (A), lateral shift (B), and Cobb angle (C).

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  Fig. 4 The correlation between improvement in spinal deformities and age at the time of surgery. The CMA ratio (A) and LS ratio (B) increased slightly with increasing age at the time of surgery. (C) The CA ratio increased significently with increasing age at the time of surgery. CMA, cervicomandibular angle; LS, lateral shift; CA, Cobb angle.

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