Evidence for shoulder girdle dystonia in selected patients with cervical disc prolapse.
Some patients with cervical disc herniation suffer from persistent nuchal pain and muscle spasms after decompressive surgery despite the lack of clinical and radiological signs for actual spinal root compression. Sonographic examination of the brain in some of these patients showed increased echogenicity of the lentiform nuclei as described in patients with idiopathic dystonia. This has been linked to an altered Menkes protein level and copper metabolism. We suggest a relationship between persistent nuchal pain after adequate cervical disc surgery and dystonic movement disorders. Thirteen patients with persistent nonradicular nuchal pain after at least one cervical disc surgery and without evidence of continuing spinal root compression and 13 age-matched controls were included. All patients had a complete neurological examination, ultrasound, and MRI scan of the brain. In addition, Menkes protein mRNA levels of leucocytes were analyzed in patients and controls. All patients with persistent nuchal pain exhibited a constant tonic unilateral shoulder elevation associated with an ipsilateral hypertrophy of the trapezius muscle. Ultrasound examination showed an increased echogenicity of the lentiform nucleus in one patient unilaterally and in 10 patients bilaterally but in none of the controls. On MRI the T2-values of the lentiform nuclei were found to be higher in patients exhibiting a hyperechogenicity of the lentiform nuclei compared to controls (P = 0.01). In addition, Menkes protein mRNA levels were decreased in patients with cervical disc herniation (P = 0.03). Clinical, neuroimaging, and biochemical findings of this selected patient sample with chronic nuchal pain and muscle spasms after cervical disc surgery resemble alterations in patients with idiopathic cervical dystonia. This suggests a link between both disorders. A peripheral trauma to the nerve roots may precipitate dystonic movements in susceptible patients and chronic dystonic muscle contraction would account for the persistent nuchal pain.
Becker
Georg
G
Department of Neurology, Bayerische Julius-Maximilians-Universität Würzburg, Germany. georg.becker@uniklinik-saarland.de
Berg
Daniela
D
Kruse
Niels
N
Schröder
Ute
U
Warmuth-Metz
Monika
M
Rieckmann
Peter
P
Naumann
Markus
M
Reiners
Karlheinz
K
D000251:Adenosine Triphosphatases / Q000235:genetics; D000328:Adult; D020968:Brachial Plexus Neuritis / Q000175:diagnosis* / Q000209:etiology / Q000503:physiopathology; D027682:Cation Transport Proteins / Q000235:genetics; D002574:Cervical Vertebrae / Q000601:surgery*; D002908:Chronic Disease; D000073840:Copper-Transporting ATPases; D003342:Corpus Striatum / Q000473:pathology / Q000503:physiopathology; D004292:Dominance, Cerebral / Q000502:physiology; D020821:Dystonic Disorders / Q000175:diagnosis* / Q000209:etiology / Q000503:physiopathology; D004453:Echoencephalography; D004576:Electromyography; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D007405:Intervertebral Disc Displacement / Q000601:surgery*; D008279:Magnetic Resonance Imaging; D008297:Male; D008875:Middle Aged; D019547:Neck Pain / Q000209:etiology; D009408:Nerve Compression Syndromes / Q000175:diagnosis* / Q000209:etiology / Q000503:physiopathology; D009460:Neurologic Examination; D011183:Postoperative Complications / Q000175:diagnosis* / Q000209:etiology / Q000503:physiopathology; D012333:RNA, Messenger / Q000235:genetics; D011993:Recombinant Fusion Proteins; D013126:Spinal Nerve Roots / Q000473:pathology / Q000503:physiopathology
D027682:Cation Transport Proteins; D012333:RNA, Messenger; D011993:Recombinant Fusion Proteins; D000251:Adenosine Triphosphatases; C081184:ATP7A protein, human; D000073840:Copper-Transporting ATPases