Disclosures: Michael E. Farrell, II, MD, DC: No financial relationships or conflicts of interest
Objective: Describe a safe and reliable technique for ultrasound-guided Botulinum Toxin (BoNT) injection for the management of Cervical Dystonia (CD) with anterocollis caused by involvement of the Longus Colli and Capitis muscles.
Design: Descriptive research of a technical approach. Setting : Outpatient Neurotoxin Clinic Participants : All patients were enrolled in research protocols at the host institution and determined to have CD with a predominant anterocollis pattern.
Interventions: Patients were seated with their heads placed in maximum contralateral rotation. Direct ultrasound visualization of the longus colli and longus capitis musculature was achieved using anatomic landmarks which included the distinct anterior tubercle of the C6 vertebra. Identification and avoidance of vulnerable neurologic structures including the vagus nerve, sympathetic ganglion, and carotid vessels was possible using this positioning.
Main Outcome Measures: Direct needle visualization into the longus capitis and longus colli using ultrasound guidance, confirmed with intramuscular electromyography.
Results: Ultrasound visualization and treatment of the longus colli and longus capitis with BoNT can be performed reliably using the anterior tubercle of the C6 vertebra as an anatomic landmark. A safe anatomic window for needle trajectory can be best visualized with subjects in a seated position and head placed in maximum contralateral rotation. Conclusions: Treatment of the longus colli and longus capitis muscles using BoNT injection in CD can be reliably performed with direct ultrasound visualization by positioning the patient with maximum contralateral head rotation and identification and location of the target musculature using the C6 anterior tubercle as a landmark.
Level of Evidence: Level V
To cite this abstract in AMA style:
Farrell ME, Alter KE, Berrigan W, Yonter S. Ultrasound Guided Botulinum Toxin Injection Technique for Treatment of Longus Colli and Capits in Cervical Dystonia [abstract]. PM R. 2020; 12(S1)(suppl 1). https://pmrjabstracts.org/abstract/ultrasound-guided-botulinum-toxin-injection-technique-for-treatment-of-longus-colli-and-capits-in-cervical-dystonia/. Accessed May 14, 2025.« Back to AAPM&R Annual Assembly 2020
PM&R Meeting Abstracts - https://pmrjabstracts.org/abstract/ultrasound-guided-botulinum-toxin-injection-technique-for-treatment-of-longus-colli-and-capits-in-cervical-dystonia/