Figure 1
Flowchart of included and excluded patients.
Table 1
Demographics and Clinical characteristics.
| S | AGE IN YRS | SEX | YRS SINCE CD ONSET | YRS SINCE CD DX | INTERVAL BETWEEN CD ONSET & CERVICAL SPINE DX IN YRS | CERVICAL SPINE DIAGNOSIS | SURGICAL PROCEDURES | NON–SURGICAL PAIN PROCEDURES | CERVICAL SPINE LEVEL | MULTIPLE SPINE PROCEDURES | |||||||||
|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|
| CCS | RADI | MYEL | AAD | DISC | PCF | ACDF | LAMI | RODS | MBB | RA | EPIDURAL STEROID &/OR LIDOCAINE | ||||||||
| 1 | 59 | F | 13 | 9 | <5 | + | + | + | – | + | – | + | + | – | – | + | + | C4, C5, C6 | + |
| 2 | 76 | F | 18 | 15 | 5–10 | – | – | – | – | + | – | + | + | – | + | – | + | C2, C3, C4, C5, C6, C7 | + |
| 3 | 65 | F | 15 | 15 | 5 | + | – | + | – | + | + | + | + | – | – | – | – | C4, C5 | + |
| 4 | 64 | F | 6 | 6 | <5 | + | + | – | – | + | – | – | – | – | + | – | – | C2, C3, C4, C5 | + |
| 5 | 65 | M | 21 | 14 | <5 | – | + | + | – | – | – | – | – | – | – | – | – | C4, C5, C6 | + |
| 6 | 37 | M | 17 | 2 | <5 | – | – | – | – | – | – | – | – | – | + | + | + | C2, C3 | + |
| 7 | 83 | F | 14 | 14 | <5 | + | – | – | – | – | – | – | – | – | – | – | – | C3, C4, C5, C6 | – |
| 8 | 46 | M | 6 | 5 | <5 | + | – | + | – | – | – | – | – | – | – | – | + | C3, C4 | – |
| 9 | 90 | M | 24 | 21 | >10 | – | + | – | – | – | – | – | – | – | – | – | – | unknown | – |
| 10 | 79 | M | 15 | 15 | 5–10 | + | – | – | – | – | – | – | – | – | – | – | + | C5, C6, C7 | – |
| 11 | 71 | F | 21 | 17 | >10 | + | – | – | – | – | – | – | – | – | – | – | + | unknown | – |
| 12 | 55 | F | 6 | 6 | <5 | + | – | – | – | – | – | – | – | – | + | – | – | C4, C5, C6 | – |
| 13 | 76 | F | 16 | 16 | 5–10 | – | – | – | – | – | – | – | – | – | + | – | – | unknown | – |
| 14 | 68 | F | 8 | 8 | <5 | + | – | – | – | – | – | – | – | – | – | – | – | unknown | – |
| 15 | 85 | F | 8 | 8 | <5 | + | – | – | – | – | – | – | – | – | – | – | + | C4, C5, C6 | – |
| 16 | 76 | M | 11 | 10 | 5–10 | + | – | – | – | – | – | – | – | – | – | – | + | C4, C5, C6 | – |
| 17 | 76 | F | 17 | 17 | >10 | – | + | – | – | – | – | – | – | – | – | – | – | C5, C6, C7, C8 | – |
[i] +, present; –, absent; Subject number, S; cervical canal stenosis, CCS; radiculopathy, Radi; myelopathy, Myel; atlantoaxial dislocation, AAD; discectomy, Disc; posterior cervical fusion, PCF; anterior cervical discectomy and fusion, ACDF; laminectomy, Lami; medial branch block, MBB; radiofrequency ablation, RA.
Table 2
Pharmacological treatments for cervical dystonia and cervical spine diagnosis.
| S | MUSCLE RELAXANTS: CHZ, CYCLO, MCB, MTX | BENZODIAZEPINES: CLZ, DZP, LZP, ALP | ANTICHOLINERGICS: BZT, THP | OTHER PSYCHOTROPIC MEDS: GBP, PGB, DUL, VEN | PAIN MEDICATIONS: HC, OXY TRD, MS, FEN | BOTULINUM (BONT) FORMULATION AND DOSE | IMPROVEMENT RESPONSE TO BOTULINUM AFTER CERVICAL SPINE DIAGNOSIS |
|---|---|---|---|---|---|---|---|
| 1 | CYCLO (5 mg), MCB (1000 mg) | CLZ* (1 mg), DZP (5 mg) | THP (4 mg) | GBP (600 mg), PGB* (100 mg), VEN* (75 mg) | HC (5–325 mg), TRD (50 mg), OXY (10 mg), FEN (2 mg) | Ona-BoNT; 300 units | moderate |
| 2 | CYCLO (15 mg) | LZP (1 mg), ALP (0.5 mg) | THP (6 mg) | GBP (1800 mg), PGB (100 mg), DUL (30 mg), VEN (37.5 mg) | OXY (10 mg) | Rima-BoNT; 10000 units | moderate |
| 3 | CYCLO (30 mg), MCB (2250 mg) | CLZ* (2 mg), DZP (5 mg), ALP (1 mg) | THP (4 mg) | GBP (300 mg), PGB* (450 mg) | OXY (5 mg), FEN (25 mcg), HC (10 mg) | Rima-BoNT; 5000 units | moderate |
| 4 | CYCLO (30 mg) | DZP (15 mg), LZP* (0.5 mg) | N/A | GBP (no dosage specified) | HC (5–325 mg), OXY (10–325 mg), MS (4 mg) | Ona-BoNT; 400 units | mild |
| 5 | N/A | N/A | THP* (6 mg) | GBP (600 mg) | TRD (50 mg) | Ona-BoNT; 100 units | moderate |
| 6 | CYCLO (10 mg) | CLZ* (1 mg) | N/A | N/A | FEN (50–250 mcg) | Ona-BoNT; 400 units | mild |
| 7 | CYCLO (5 mg) | CLZ* (0.5 mg), LZP (1 mg), ALP (0.5 mg) | N/A | GBP (1200 mg) | TRD (50 mg), OXY (5 mg), | Ona-BoNT; 300 units | marked |
| 8 | CYCLO (30 mg) | DZP (10 mg), LZP* (1 mg) | N/A | GBP* (300 mg) | OXY (10 mg), TRD (50 mg), MS (15 mg) | Ona-BoNT; 400 units | moderate |
| 9 | CYCLO (15 mg) | CLZ* (1.5 mg) | N/A | DUL (30 mg) | TRD (100 mg) | Ona-BoNT; 360 units | mild |
| 10 | CYCLO (15 mg) | CLZ* (3 mg) | THP (4 mg) | VEN (75 mg) | OXY (10 mg), TRD (50 mg), MS (15 mg), FEN (50 mcg) | Inco-BoNT; 350 units | mild |
| 11 | MCB (500 mg) | CLZ* (1.5 mg), DZP (5 mg) | N/A | GBP (300 mg), VEN (75 mg) | OXY (10 mg), TRD (50 mg), MS (50 mcg) | Rima-BoNT; 15000 units | moderate |
| 12 | CYCLO (5 mg) | LZP* (1 mg), DZP (10 mg) | N/A | GBP* (1800 mg), DUL (120 mg), VEN (75 mg) | OXY (10 mg), MS (30 mg), HC (5–325 mg), TRD (50 mg) | Ona-BoNT; 300 units | mild |
| 13 | CYCLO* (15 mg) | CLZ (1 mg) | N/A | N/A | *BACC | Rima-BoNT; 15000 units | moderate |
| 14 | CYCLO (15 mg) | CLZ (1 mg) | THP (4 mg) | DUL (20 mg), VEN (37.5) | TRD (50 mg), MS (2 mg) | Ona-BoNT; 100 units | moderate |
| 15 | CYCLO (15 mg) | DZP (5 mg), LZP (2 mg), ALP (0.25 mg) | N/A | GBP (200 mg), VEN (75 mg) | HC (5–325 mg), OXY (5–325 mg), TRD (50 mg), MS (2 mg) | Ona-BoNT; 240 units | moderate |
| 16 | CYCLO* (30 mg) | N/A | N/A | GBP* (300 mg), DUL* (60 mg), VEN* (75 mg) | TRD (50 mg), MS (2 mg) | Ona-BoNT; 450 units | moderate |
| 17 | MCB* (750 mg) | N/A | N/A | GBP* (600 mg) | OXY (50 mg), TRD (50 mg) | Ona-BoNT; 200 units | marked |
[i] Subject number, S; chlorzoxazone, CHZ; Cyclobenzaprine, CYCLO; methocarbamol, MCB; metaxalone, MTX; clonazepam, CLZ; diazepam, DZP; lorazepam, LZP; alprazolam, ALP; benztropine, BZT; trihexyphenidyl, THP; hydrocodone, HYD; Oxycodone, Oxy; tramadol, TML; morphine, MOR; Fentanyl, Fent; gabapentin, GBP; pregabalin, PGB; duloxetine, DUL; venlafaxine, VEN; Botulinum toxin, BoNT; Ona botulinum toxin type A, Ona; Inco botulinum toxin type A, Inco; Rima botulinum toxin type B, Rima; butalbital-acetaminophen-caffeine-codeine, BACC. * Active meds.
Table 3
Summary of Study Characteristics from Published Literature (chronologically).
| AUTHOR | STUDY TYPE | YEAR OF PUBLICATION | COUNTRY, CONTINENT | CERVICAL SPINE DIAGNOSIS | N/N | MEAN AGE IN YEARS | WHAT % DEVELOP | M:F | AGE OF ONSET |
|---|---|---|---|---|---|---|---|---|---|
| Chen et al. REF 6 | Case series | 2012 | Taiwan, Asia | cervical myelopathy, cord compression at C3–C4, C4–C5, & C5–C6, discectomy & interbody fusion cage at C3–C4 | 10/10 | 53 | N/A | 7:3 | 24.9 |
| Wong et al. REF 7 | Case series | 2005 | Canada, North America | cervical myeloradiculopathy, disc fusion C1–C2 laminectomy C4–C5 | 1/8 | 44 | N/A | 1:0 | 44 |
| Krauss et al. REF 8 | Case series | 2002 | Germany, Europe | cervical myelopathy, cervical spondylosis at C3–C4 & C4–C5, anterior plate stabilization C3–C5 | 8/8 | 43 | N/A | 5:3 | 34 |
| Hagenah et al. REF 9 | Chart review | 2001 | Germany, Europe | cervical radiculopathy and myelopathy, spondylosis at C2–C3, C4–C5, & C5–C6, sequestrectomy, herniation of C6–C7 | 6/34 | 53.6 | 18% | 3:3 | 45.9 |
| Weigel et al. REF 10 | Case report | 2001 | Germany, Europe | osseous fusion, partial myectomy, posterior ramisectomy C1–C6 | 1/1 | 31 | N/A | 1:0 | 23 |
| Dalvie et al. REF 13 | Case report | 2000 | India, Asia | C1–C2 rotary subluxation, posterior fusion of C1–C2 | 1/1 | 37 | N/A | 1:0 | N/A |
| Al–Jishi et al. REF 11 | Case report | 2000 | Bahrain, Asia | atlantoaxial subluxation & cord compression at C5–C6 & C6–C7, cervical myeloradiculopathy, disc fusion | 1/1 | 46 | N/A | 1:0 | “childhood” |
| Chawda et al. REF 12 | Case series | 2000 | United Kingdom, Europe | cervical spondylosis at C2–C3 & C3–C4, selective peripheral denervation surgery | 14/34 | 53.5 | 41% | 6:8 | 42 |
| Adler et al. REF 14 | Case series | 1996 | USA, North America | cervical radiculomyelopathy, C5 fracture, anterior fusion at C6–C7, posterior fusion, laminectomy at C3–T2, post operative botulinum toxin | 3/4 | N/A | N/A | 1:0 | N/A |
| Defazio et al. REF 15 | Case report | 1993 | Italy, Europe | cervical radiculopathy, cervical root impairment at C7–T1 | 1/1 | 49 | N/A | 0:1 | “childhood” |
| Polk et al. REF 16 | Case report | 1992 | USA, North America | cervical radiculopathy & myelopathy, spondylosis at C3–C7, cord compression, laminectomy C3–C7 | 1/1 | 34 | N/A | 1:0 | “childhood” |
| Jankovic et al. REF 4 | Chart review | 1991 | USA, North America | cervical radiculopathy & myelopathy, selective cervical rhizotomy* | 96/300 | 49.7 | 32% | N/A | 41.9 |
| Waterson et al. REF 17 | Case series | 1989 | United Kingdom, Europe | cervical myelopathy, laminectomy at C1, posterior fusion at C4, anterior fusion at C3–C4, and forward subluxation of C2–C3 & C3–C4 | 2/2 | 61 and 19 | N/A | 2:0 | N/A |
[i] Values are shown as mean if exact number was not available in the article. Number of subjects, n; Male, M; Female, F.
*Cervical level not indicated in paper.