2034 Outcomes of Distal Sternocleidomastoid Stump Resection Following Selective Denervation as Revision Surgery in Refractory Cervical Dystonia

INTRODUCTION: Cervical dystonia (or spasmodic torticollis) is a neurological condition characterized by sustained, involuntary contractions of the neck and shoulder muscles, resulting in abnormal movements and head posture. METHODS: This is a retrospective single-center cohort study of patients who underwent SCME as revision surgery for cervical dystonia. RESULTS: 18 patients (10 males; 56%) were included with a median age of 54 (range: 4-70). All patients received selective denervation at our institution prior to SCME. At baseline, 13 patients (72%) possessed a rotational torticollis component to their head deviation, 12 (67%) possessed a laterocollis component, and two (11%) possessed a retrocollis component, with a median maximal head deviation of 53° (range:30-90°). At most recent follow-up (median:16 months), the median maximal head deviation was 10° (range:0-35°). Six patients had complete resolution of their cervical dystonia (33%), 10 had persistent deviation (33%), and two had recurrent deviation (11%). Compared to their post-selective denervation head position, 12 patients experienced improvement in their head position (67%), four patients had no change in their head position (22%), and two had worsening of their cervical dystonia (11%) following SCME. Patients that experienced full resolution of their cervical dystonia post-SCME had shorter time between initial selective denervation surgery and SCME versus those individuals that experienced persistent/recurrent cervical dystonia (6.5 vs 28 months, respectively), though this result did not achieve statistical significance (p=0.068). CONCLUSIONS: SCME following selective denervation is a safe and effective option for many patients in treating refractory cervical dystonia. Patients that have a shorter time interval between selective denervation and SCME may be more likely to achieve a straight head position postoperatively, though additional investigations are needed.