PREOPERATIVE TREATMENT WITH BOTULINUM TOXIN TO FACILITATE CERVICAL FUSION IN DYSTONIC CEREBRAL-PALSY - REPORT OF 2 CASES

The authors report the use of high-dose botulinum toxin A for muscle r elaxation prior to surgery for cervical spine fixation in two patients with dystonic cerebral palsy that included severe cervical dystonia. Both patients had recently developed progressive cervical myelopathy a nd surgery was planned to halt the insidious progressive weakness. How ever, marked dystonic posturing of the neck would have compromised the ir tolerance of halo fixation and subsequently impeded postoperative f usion. Preoperative chemodenervation of selected cervical muscles with injections of high-dose botulinum toxin A eliminated all involuntary neck movements, permitting the patients to tolerate halo fixation and facilitating postoperative spinal fusion. It is concluded that botulin um toxin A can be used safely and effectively in the preoperative mana gement of patients with cervical dystonia and cervical spondylitic mye lopathy.