MedStar/Georgetown University National Rehabilitation Hospital, Washington, DC 20010, USA.
National Institutes of Neurological Disorders and Stroke, Bethesda, MD, 20892 USA.
Toxins (Basel). 2020 Sep 30;12(10):626. doi: 10.3390/toxins12100626.
Chemodenervation of cervical musculature using botulinum neurotoxin (BoNT) is established as the gold standard or treatment of choice for management of Cervical Dystonia (CD). The success of BoNT procedures is measured by improved symptomology while minimizing side effects and is dependent upon many factors including: clinical pattern recognition, identifying contributory muscles, BoNT dosage, and locating and safely injecting target muscles. In patients with CD, treatment of anterocollis (forward flexion of the neck) and anterocaput (anterocapitis) (forward flexion of the head) are inarguably challenging. The longus Colli (LoCol) and longus capitis (LoCap) muscles, two deep cervical spine and head flexor muscles, frequently contribute to these patterns. Localizing and safely injecting these muscles is particularly challenging owing to their deep location and the complex regional anatomy which includes critical neurovascular and other structures. Ultrasound (US) guidance provides direct visualization of the LoCol, LoCap, other cervical muscles and adjacent structures reducing the risks and side effects while improving the clinical outcome of BoNT for these conditions. The addition of electromyography (EMG) provides confirmation of muscle activity within the target muscle. Within this manuscript, we present a technical description of a novel US guided approach (combined with EMG) for BoNT injection into the LoCol and LoCap muscles for the management of anterocollis and anterocaput in patients with CD.
使用肉毒毒素（BoNT）化学神经切断术治疗颈部肌肉是治疗颈肌张力障碍（CD）的金标准或首选治疗方法。BoNT 程序的成功通过改善症状来衡量，同时尽量减少副作用，这取决于许多因素，包括：临床模式识别、确定相关肌肉、BoNT 剂量以及定位和安全注射目标肌肉。在 CD 患者中，治疗前屈颈（颈部前屈）和前颅（前颅）（头部前屈）无疑具有挑战性。颈长肌（LoCol）和头长肌（LoCap）这两块深层颈椎和头部屈肌经常参与这些模式。由于这些肌肉位置深，以及包括关键的神经血管和其他结构在内的复杂区域解剖结构，因此定位和安全注射这些肌肉特别具有挑战性。超声（US）引导提供了 LoCol、LoCap、其他颈部肌肉和相邻结构的直接可视化，降低了风险和副作用，同时提高了 BoNT 治疗这些疾病的临床效果。肌电图（EMG）的加入提供了目标肌肉内肌肉活动的确认。在本文中，我们介绍了一种新的超声引导方法（结合 EMG）的技术描述，用于 BoNT 注射到 LoCol 和 LoCap 肌肉，以治疗 CD 患者的前屈颈和前颅。
