What are Torticollis and Spasmodic Torticollis?

Torticollis is one of a class of "movement disorders" sometimes called "dystonias."  Torticollis and Spasmodic Torticollis cause persistent or rhythmic  tilting or twisting of the head and neck in infants, adolescents, and some adults.  In infants, the condition may be associated with abnormal head shape due to plagiocephaly or craniosynostosis (premature fusion of one or more of the natural cranial joins of the infant skull) [see Reference].  Spasmodic torticollis may also result from compression of the 11th cranial nerve by a tumor or blood vessels within the skull. 

"Congenital muscular torticollis (wry neck) results from shortening of the  sternocleidomastoid muscle and may lead to limitation of neck movement and  craniofacial deformity. If conservative treatment is started early, with a regimen of passive stretching exercises and active strengthening of the contralateral muscle, about 95% of patients achieve an acceptable range of neck movement. Surgical
management of patients who do not respond to physiotherapy remains controversial."  [Reference: Stassen LF, Kerawala CJ, "New surgical technique for the correction of congenital muscular torticollis (wry neck)."]

Other structural problems of the cervical spine and neck muscles may also be involved. "The most dangerous cause of non-muscular acquired torticollis is related to neurologic syndromes, such as syringomyelia, dystonic or post-encephalitic syndromes, herniated cervical discs, and, especially, posterior fossa pathology." [Reference: Daniel R. Cooperman "Differential Diagnosis of Torticollis in Children"]. 

How are Torticollis and Spasmodic Torticollis Diagnosed?

CT scan may be used to distinguish between structural conditions associated with Torticollis  [Reference] and to aid in treatment selection.  Symptoms of these disorders may emerge due to several overlapping causes, including hereditary or congenital disorders, birth injury and stroke.  [Reference] Thus, careful assessment for movement disorders is necessary  by a specialist in neurology or neurosurgery.

How are Torticollis and Spasmodic Torticollis Treated?

Several avenues of treatment have been applied with varying degrees of consistency and success.  Alternatives for infants may focus on passive positioning and exercise to stretch short muscles in the neck, or use of neck collars ("splinting").   In children and adults, biofeedback, stress management, Botulinum toxin A ("Botox") shots have been applied with  a mixed record of success and failure.  

Surgical procedures are also used, including intradural selective rhizotomy and microvascular decompression.  The medical team at WPAHS includes physicians who have successfully treated spasmodic torticollis with microvascular decompression.  In one published study, this procedure eliminated or greatly reduced spasms in over 80% of 20 documented cases that were followed for five to ten years after surgery. 

[Abstract:  Jho HD, Jannetta PJ]
 Full Text Article: [Full text PDF file]
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Where Can I Find a Healthcare Professional Who Treats Torticollis?
The Treatment Team at WPAHS
Peter Jannetta, M.D., Professor of Neurosurgery, Allegheny General Hospital. Jon Brillman, M.D.  Director, Division of Neurology,  Professor of Neurology, Medical College of Pennsylvania  and Hahnemann University
  • Medical Career and Accomplishments
  • Treatment Interests:
  • Publications (Abstracts) [Note: J Brillman and JC Brillman are not the same person]
  • To contact Dr. Brillman
    • Susan M. Baser, M.D. Allegheny General Back Institute, Department of Neurology, Allegheny General Hospital
  • Medical Career and Accomplishments
  • Treatment Interests: Parkinson's disease/syndromes; movement disorders; Huntington's chorea; tremors; hypertension and Torticollis
  • Publications (Abstracts from Pub Med)  and Vitae
  • To contact Dr. Baser
    • Patient Support Groups and Bulletin Boards
    Craniosynostosis and Parents Support
    Neurology Web Forums at Massachusetts General Hospital -- http://neuro-mancer.mgh.harvard.edu/cgi-bin/Ultimate.cgi -- over 170  patient-to-patient bulletin-boards for exchange of concerns and information.

    Spasmodic Torticollis Bulletin Board Archive --Doc Shop Mall Health Resources.

    Additional Information on the Internet
    Plagiocephaly.org -- Information on the assessment and correction of abnormal head shape.

    Dystonias -- fact sheet from the National Institute of Neurological Disorders and Stroke.

    Amazon.com lists a book titled "Torticollis : Differential Diagnosis, Assessment, and Treatment, Surgical Management and Bracing (for Pediatrics)." 


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    Last Updated: September 21, 2000
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