Pre-operative Botulinum Toxin Injection for Movement Disorder-induced Cervical Spondylosis

Movement disorder is characterized by unique, unusual movements that are repetitive, and involuntary cervical motion has been well established to cause cervical spondylosis. The purpose of this study was to investigate the management of neurological and orthopedic complications in patients with movement disorder induced cervical spondylosis by botulinum toxin injection to provide immobilization of neck. In this retrospective study, 6 patients during the period from 2003 to 2010 were diagnosed with movement disorder-induced cervical spondylosis by neurologists. Each patient received botulinum toxin injection with a total dosage of 500-600U in the sternocleidomastoid, trapezius, splenius capitis, levator scapulae one week prior to surgery. Patients' demographics, diagnoses, injected dosage of botulinum toxin, and operative methods are retrospectively collected. All patients had a repeat cervical spine X-ray to assess the fusion and integrity of the construct. The clinical outcomes were assessed by using modified Rankin scale (mRS). The duration of follow-up was measured from the date of operation to the date of the last clinic visit. The mean age of our patients was 47.2 years ranging from 31 to 64 years. There was a male gender predilection with a male/female ratio of 4:2. The causing diseases prior to cervical spondylosis in our six patients were as follows: cerebral palsy in 3 patients, spasmodic torticollis in 2, and tardive dyskinesia in 1. At the mean follow-up of 56.5 months, all patients had improvement in their daily activities, and the average ratio of improvement in mRS was 41%. Cervical spine X-ray series showed no evidence of implant failure in any of the patients. Intramuscular injection of botulinum toxin provided post-operative immobilization of the neck for treatment of movement disorder-induced cervical spondylosis. These patients need long-term follow up for monitoring of adjacent segmental degeneration.

並列關鍵字

botulinum toxin ； movement disorder ； spondylosis ； myelopathy ； spinal fusion

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