The Surgical Treatment of Spasmodic Torticollis

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THE involuntary, uncomfortable, and irregular jerking movements of the head which characterize spasmodic torticollis impose a physical and mental burden upon the patient. They interfere with and sometimes prevent the proper performance of occupational duties and enjoyment of social activities. The disorder has been recognized for centuries and has failed to respond to many forms of treatment. However, modern neurosurgical technics have brought many successful results.

Spasmodic torticollis has been adequately defined by Patterson and Little1 as “an involuntary hyperkinesis manifesting itself by mobile, tonic, or clonic spasms of the neck musculature, and producing more or less stereotyped deviation of the head into an abnormal position, the chin being rotated to one side or the head bent directly forward (antecollis) or backward (retrocollis).” The spasms are abolished by sleep and aggravated by emotional stress, but the cause of the disorder is not known. Although a pure psychogenic origin is upheld by a few neurologists, such a cause is extremely rare, and most modern writers favor the theory of organic origin. This condition must be differentiated from the ischemic or traumatic wry-neck of childhood due to injury o t the sternomastoid muscle; in the latter there is a constant contraction due to shortening of the muscle as a result of infiltration of the intramuscular fasciae, as pointed out by Rugh,2 while the muscle contractions of spasmodic torticollis are irregular and clonic in nature. It is also obviously different from the constant moderate head tilt observed in ocular torticollis, caused by disorders. . .



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