Spondylotic myelopathy in patients with cervical dystonia

The treatment and outcome of cervical dystonia (CD) with myelopathy (CDM) varies among studies. We retrospectively reviewed the clinical features, neuroimages, methods of treatment, and modified Rankin scale (mRS) score of patients with CDM in our hospital. There were seven male and three female patients, with a mean age of 53 years. The mean age at onset of CD was 24.9 years, with a mean interval from dystonia to the diagnosis with myelopathy of 28.1 years. The dominant level of cord compression was at C3/C4 in seven patients, C4/C5 in one patient, and C5/C6 in two patients. Four of five patients with an initial mRS ≥ 3 remained moderately to severely disabled after surgery, with a follow-up periods of 3-5 years, and one of them experienced recurrent cage dislocation and neurological deterioration due to an unstable spine. Perioperative stabilization is important to minimize neurological sequelae. Whether surgical intervention improves the functional outcome of patients with moderate-to-severe disability demands further randomized controlled studies.