Myotomy and Selective Peripheral Denervation Based on 18F-FDG PET/CT in Intractable Cervical Dystonia: A Case Report

Abstract

Cervical dystonia, characterized by the involuntary contraction of cervical muscles, is the most common form of adult dystonia. In a patient with intractable cervical dystonia, we carried out a myotomy of the left obliquus capitis inferior and selective peripheral denervation (SPD) of the posterior branches of the C3-C6 spinal nerves based on preoperative 18F-fluorodeoxyglucose (¹⁸F-FDG) positron emission tomography/computed tomography (PET/CT). The patient was a 65-year-old, right-handed man with an unremarkable medical history. His head rotated involuntarily to the left. Medication and botulinum toxin injections were ineffective, and surgical treatment was considered. ¹⁸F-FDG PET/CT imaging revealed FDG uptake in the left obliquus capitis inferior, right sternocleidomastoideus, and left splenius capitis. Myotomy of the left obliquus capitis inferior and SPD of the posterior branches of the C3-C6 spinal nerves was performed under general anesthesia. During the 6-month follow-up, the patient's Toronto Western Spasmodic Torticollis Rating Scale score improved from 35 to 9. This case shows that preoperative ¹⁸F-FDG PET/CT is effective in identifying dystonic muscles and determining the surgical strategy for cervical dystonia.

Keywords: 18F-FDG PET/CT; cervical dystonia; myotomy; selective peripheral denervation.

Fig. 1

Improvement of the patient’s cervical posture following selective peripheral denervation. Neutral cervical posture before the surgery (a) and after the surgery (b).

Fig. 2

18F-fluorodeoxyglucose (¹⁸F-FDG) positron emission tomography/computed tomography axial imaging. The image shows abnormally high FDG uptake in the left obliquus capitis inferior (arrow) (a), right sternocleidomastoideus (dotted arrow), and left splenius capitis (arrow) (b).