Chu Eric Chun-Pu, Lo Fa-Sain, Bhaumik Amiya
New York Chiropractic & Physiotherapy Centre, New York Medical Group, Hong Kong, China.
Faculty of Sciences, Lincoln University College, Kelantan, Malaysia.
AME Case Rep. 2020 Apr 30;4:9. doi: 10.21037/acr.2020.03.03. eCollection 2020.
Dystonia is a neurological disorder characterized by sustained or intermittent muscle contractions resulting in twisting, repetitive movements or painful postures. Cervical dystonia (CD), an isolated dystonia of the cervical musculature, can predispose the atlantoaxial joint to unstable changes. Symptomatic treatment of dystonia through local injections of botulinum toxin clearly reduces pain in most clinical settings. However, repeated chemodenervation of the involved muscles with neurotoxin is expensive and not available to the complicated cases of CD. In this report a 14-year-old girl with a 1-year history of CD complicated by atlantoaxial subluxation was treated using chiropractic intervention. As a result of this regimen, the girl reported a significant relief from the neck pain and torticollis after the first week. More gains of cervical range of motion were made over the course of 6 months of treatment. Chiropractic might have yielded some biomechanical responses linked to clinical effects. This case demonstrates an unexpected association between CD and atlantoaxial subluxation. In cases of CDs, atlantoaxial subluxation may be ignored but requires specialized treatment. An index of suspicion should be maintained for this rare but potentially debilitating complication.
肌张力障碍是一种神经系统疾病，其特征是肌肉持续或间歇性收缩，导致扭曲、重复性动作或疼痛性姿势。颈部肌张力障碍（CD）是一种孤立的颈部肌肉肌张力障碍，可使寰枢关节易于发生不稳定变化。在大多数临床情况下，通过局部注射肉毒杆菌毒素对症治疗肌张力障碍可明显减轻疼痛。然而，用神经毒素对受累肌肉反复进行化学去神经支配费用高昂，且复杂的CD病例无法采用这种方法。在本报告中，一名患有1年CD病史并伴有寰枢椎半脱位的14岁女孩接受了整脊干预治疗。经过这一疗程，该女孩在第一周后报告颈部疼痛和斜颈明显缓解。在6个月的治疗过程中，颈椎活动范围有了更多改善。整脊疗法可能产生了一些与临床效果相关的生物力学反应。该病例显示了CD与寰枢椎半脱位之间意想不到的关联。在CD病例中，寰枢椎半脱位可能被忽视，但需要专门治疗。对于这种罕见但可能使人衰弱的并发症应保持怀疑指数。
