Craniovertebral Junction Abnormalities in Surgical Patients With Congenital Muscular Torticollis

Our clinical experience led us to realize that craniovertebral junction (CVJ) abnormalities were common in surgical patients with congenital muscular torticollis (CMT). This study aimed to report the concurrence rate of CVJ abnormalities in surgical patients with CMT, along with comprehensive evaluation of type of concurrent CVJ abnormalities. This was a retrospective cohort study in a tertiary hospital, including 41 subjects who underwent surgical release for CMT at the mean age of 8.38 years. The presence of CVJ abnormalities was analyzed, using craniofacial 3-dimensional computed tomography images. The concurrence rate of CVJ abnormalities was 70% in surgical patients with CMT. Subjects with CVJ abnormalities had, on average, 1.48 abnormalities. The CVJ abnormalities were rotation and lateral shift of the atlanto-axial joint along with rotation of atlanto-occipital joint, where rotation of the atlanto-axial joint was most common (82.76%). There is no patient with anterior shift of the atlanto-axial joint. Chronic mechanical tension by the contracted unilateral sternocleidomastoid muscle of CMT could be responsible for concurrent CVJ abnormalities. The CVJ abnormalities are more common in the atlanto-axial joint than in the atlanto-occipital joint. In conclusions, CVJ abnormality seems to be a common concurrent skeletal complication of CMT, at least, in surgical patients. The CVJ abnormality might be included in the list of skeletal complications of CMT. If CVJ abnormalities are significantly more common in surgical patients with CMT, CVJ abnormalities might be one of predictors of surgical patients with CMT. Address correspondence and reprint requests to Shin-Young Yim, MD, PhD, Department of Physical Medicine and Rehabilitation, Ajou University School of Medicine, The Center for Torticollis, 164 World cup-ro, Yeongtong-gu, Suwon 16499, Republic of Korea; E-mail: syyim@ajou.ac.kr Received 24 August, 2017 Accepted 5 January, 2018 This work was supported by the grants through the National Research Foundation of Korea funded by the Ministry Science, ICT and Future Planning, Republic of Korea (2016R1A2B1010654). The funder had no role in study design, data collection and analysis, decision to publish, or preparation of the manuscript. The authors report no conflicts of interest. © 2018 by Mutaz B. Habal, MD.

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