Fluoroscopic, EMG-guided injection of botulinum toxin into the longus colli for the treatment of anterocollis

Glass, Graham A.; Ku, Stephen; Ostrem, Jill L.; Heath, Susan; Larson, Paul S.

doi:10.1016/j.parkreldis.2009.01.006

« Previous Next »Parkinsonism & Related Disorders
Volume 15, Issue 8 , Pages 610-613, September 2009

Fluoroscopic, EMG-guided injection of botulinum toxin into the longus colli for the treatment of anterocollis

Graham A. Glass
- Dept. of Neurology, UCSF, San Francisco, CA, USA
- Parkinson's Disease Research, Education and Clinical Center, SFVAMC, San Francisco, CA, USA
- Corresponding author. Department of Neurology, UCSF Medical Center, San Francisco, CA 94143, USA. Tel.: +1 415 379 5530; fax: +1 415 750 6662.
Stephen Ku
- Parkinson's Disease Research, Education and Clinical Center, SFVAMC, San Francisco, CA, USA
Jill L. Ostrem
- Dept. of Neurology, UCSF, San Francisco, CA, USA
- Parkinson's Disease Research, Education and Clinical Center, SFVAMC, San Francisco, CA, USA
Susan Heath
- Parkinson's Disease Research, Education and Clinical Center, SFVAMC, San Francisco, CA, USA
Paul S. Larson
- Parkinson's Disease Research, Education and Clinical Center, SFVAMC, San Francisco, CA, USA
- Dept. of Neurosurgery, UCSF, San Francisco, CA, USA

Received 16 December 2008; received in revised form 25 January 2009; accepted 27 January 2009.

Abstract

Background

Anterocollis is a form of cervical dystonia characterized by forward neck flexion. While botulinum toxin is the treatment of choice for cervical dystonia, patients with anterocollis, who receive injections into the sternocleidomastoid and anterior scalene muscles, represent a disproportionate number of treatment failures. Deep cervical muscles such as the longus colli likely play an important role in neck flexion but are not routinely injected.

Objective

To describe a technique for longus colli injection in cases of anterocollis and to report the clinical outcomes of 10 such injections of botulinum toxin.

Methods

Three patients were referred for evaluation and treatment of anterocollis. All had previous treatment failures with sternocleidomastoid/anterior scalene injections or no activity noted on needle EMG investigation of these muscles. All patients received injections of botulinum toxin into the longus colli under fluoroscopic and EMG guidance.

Results

All patients experienced symptomatic improvement (eight of 10 injections). Two patients reported mild dysphagia without serious complications after dose increases in botulinum toxin.

Conclusions

Incomplete muscle selection may be one cause of treatment failures in anterocollis. Deep cervical flexors such as the longus colli represent an under-recognized potential target for symptomatic treatment of anterocollis.

Keywords: Anterocollis, Botulinum toxin, Cervical dystonia, Longus colli, Treatment