Anterocollis Anterocaput Forward Sagittal Shift
From: Jost WH, Tatu L. Selection of Muscles for Botulinum Toxin Injections in Cervical Dystonia. Mov Disord Clin Pract 2015; 2: 224–6.
Anterocollis
Anterocollis affects muscles which originate from or insert at the cervical spine, resulting in abnormal posture of the cervical spine: therefore, the neck is tilted forwards in relation to the thoracic spine; the angle between the neck and head is normal1.
Anterocaput
Head and neck form too great an angle; the angle between the cervical and thoracic spine is normal2.
Distinguishing anterocaput and and anterocollis
Analysis of forward flexion (differentiation between anterocollis and anterocaput) can be accomplished by observation from the side of the respective angles between:
- The cervical and thoracic spine (anterocollis), and
- Between the cervical spine and the base of skull (anterocaput)1.
From: Reichel G. Dystonias of the Neck: Clinico-Radiologic Correlations. In: Dystonia - The Many Facets. InTech, 2012
ANTEROCOLLIS
From: Finsterer J, Maeztu C, Revuelta GJ, Reichel G, Truong D. Collum-caput (COL-CAP) concept for conceptual anterocollis, anterocaput, and forward sagittal shift. J Neurol Sci [Internet] 2015;355(1–2):37–43.
From: Reichel G. Cervical dystonia: A new phenomenological classification for botulinum toxin therapy. Basal Ganglia [Internet] 2011;1(1):5–12.
TREATMENT
Many experts consider anterocaput/anterocollis the most difficult pattern of cervical dystonia to successfully manage with botulinum toxin3.
In anterocaput/anterocollis, the targeting challenges associated with injection of the deep flexors has led many clinicians to limit injections to the more easily accessible superficial flexor muscles, the sternocleidomastoids, and scalenus anterior. However, this traditional approach to the treatment of anterocollis is only occasionally effective and can also result in dysphagia. For example:
- Scalenus anterior attaches to the anterior tubercle of the transverse processes of the cervical spine and therefore cannot flex the head.
- Sternocleidomastoid attaches to the mastoid and therefore flexes the neck but extends the head3.
Injecting only these superficial flexor muscles may provide only limited or no benefit for those patients whose dystonic movements or postures are caused by longus capitis and longus colli over-activity. In all patients with anterocaput and in some patients with anterocollis, injection of the longus capitis or longus colli may be required to improve symptoms.
Injections of longus colli are detailed here: Section: Backward Sagittal Shift
Alternative scheme for injection: (After: Jost WH, Tatu L. Selection of Muscles for Botulinum Toxin Injections in Cervical Dystonia. Mov Disord Clin Pract 2015;2(3):224–6)
From: Finsterer J, Maeztu C, Revuelta GJ, Reichel G, Truong D. Collum-caput (COL-CAP) concept for conceptual anterocollis, anterocaput, and forward sagittal shift. J Neurol Sci 2015; 355: 37–43.
From: Finsterer J, Revuelta GJ. Anterocollis and anterocaput. Clin Neurol Neurosurg 2014; 127: 44–53.
From: Reichel G. Cervical dystonia: A new phenomenological classification for botulinum toxin therapy. Basal Ganglia 2011; 1: 5–12.
TREATMENT (After: Jost WH, Tatu L. Selection of Muscles for Botulinum Toxin Injections in Cervical Dystonia. Mov Disord Clin Pract 2015;2(3):224–6)
BILATERAL