RESUMEN
Chemodenervation of cervical musculature using botulinum neurotoxin (BoNT) is established as the gold standard or treatment of choice for management of Cervical Dystonia (CD). The success of BoNT procedures is measured by improved symptomology while minimizing side effects and is dependent upon many factors including: clinical pattern recognition, identifying contributory muscles, BoNT dosage, and locating and safely injecting target muscles. In patients with CD, treatment of anterocollis (forward flexion of the neck) and anterocaput (anterocapitis) (forward flexion of the head) are inarguably challenging. The longus Colli (LoCol) and longus capitis (LoCap) muscles, two deep cervical spine and head flexor muscles, frequently contribute to these patterns. Localizing and safely injecting these muscles is particularly challenging owing to their deep location and the complex regional anatomy which includes critical neurovascular and other structures. Ultrasound (US) guidance provides direct visualization of the LoCol, LoCap, other cervical muscles and adjacent structures reducing the risks and side effects while improving the clinical outcome of BoNT for these conditions. The addition of electromyography (EMG) provides confirmation of muscle activity within the target muscle. Within this manuscript, we present a technical description of a novel US guided approach (combined with EMG) for BoNT injection into the LoCol and LoCap muscles for the management of anterocollis and anterocaput in patients with CD.
Asunto(s)
Inhibidores de la Liberación de Acetilcolina/administración & dosificación , Toxinas Botulínicas/administración & dosificación , Electromiografía , Músculos del Cuello/inervación , Tortícolis/tratamiento farmacológico , Ultrasonografía Intervencional , Inhibidores de la Liberación de Acetilcolina/efectos adversos , Puntos Anatómicos de Referencia , Toxinas Botulínicas/efectos adversos , Humanos , Inyecciones Intramusculares , Posicionamiento del Paciente , Valor Predictivo de las Pruebas , Tortícolis/diagnóstico por imagen , Tortícolis/fisiopatología , Resultado del TratamientoRESUMEN
BACKGROUND: Anterocollis posture is a relatively rare finding among patients with cervical dystonia and often the cause of treatment failure. The dystonic posture can be complex to analyze, and the deep flexor muscles of the neck, longus capiti, and longus coli can be challenging to access. METHODS: We present a modification of a previously described endoscopic technique that allows straightforward access to the longus capiti muscles in an outpatient setting under local anesthetic. RESULTS: We describe the technique based on our experience on 6 patients during a 2-year period with a total of 22 injections, and we review the literature. CONCLUSION: The injection is well tolerated and has led to significant improvement in the majority of patients.