Spasmodic torticollis

Abstract

Seventy-one patients with spasmodic torticollis were treated surgically over an 18 year period-43 men and 28 women. The average age of onset was 43.2 years. There was no evidence to suggest a psychological origin of spasmodic torticollis. The etiology is on an organic basis, although exact site of the lesion or lesions is not known. Conservative therapy benefited only 5 patients of the 66 who received nonsurgical treatment pre-operatively. The final objective results for the entire series were: no improvement in 4 patients, minimal improvement in 6, moderate improvement in 22, and excellent improvement in 38. One patient died on the 1st postoperative day. Posterior cervical rhizotomy is of no benefit in the surgical treatment of torticollis. Basal ganglion surgery is probably beneficial in selected cases. Anterior cervical rhizotomy and subarachnoid spinal accessory nerve section should be the initial operation for spasmodic torticollis, and if further surgery therapy is deemed necessary, peripheral spinal accessory nerve section should be performed. The series indicates that surgery should be the primary treatment for spasmodic torticollis.