Effectiveness of Surgical Treatment for Neglected Congenital Muscular Torticollis: A Systematic Review and Meta-Analysis

Abstract

Background: Findings on the effectiveness of surgical release for neglected congenital muscular torticollis have been conflicting. This systematic review aims to examine the literature describing the effectiveness of surgery for neglected congenital muscular torticollis. Methods: The authors conducted a systematic review to examine the effectiveness of surgical treatment for neglected congenital muscular torticollis by means of meta-analysis. The authors searched MEDLINE, EMBASE, the Cochrane library, and KoreaMed for all articles published before May of 2014. Studies with quantitative data describing the effectiveness of surgery for congenital muscular torticollis were included. The primary outcomes after surgery were (1) clinical outcome measured by scoring systems; (2) change in range of motion of the neck; and (3) change in skeletal deformities, measured by Cobb angle and the cervicomandibular angle. Effect estimates were pooled using a random-effects meta-analysis. Results: Twelve studies were included in the review (published between 1976 and 2014), including a total of 220 patients with neglected congenital muscular torticollis. All studies used an interrupted time-series design. Surgical treatment was successful in 81 percent of cases, based on the scoring systems for surgical outcome. Outcomes of surgery performed in patients older than 15 years did not differ significantly from those of surgery performed in patients aged 15 years or younger. The range of motion of the neck and skeletal deformities showed significant improvement after surgery. Conclusions: Surgical treatment for neglected congenital muscular torticollis produced satisfactorily successful results, with improvement in both the range of motion of the neck and secondary skeletal deformities. CLINICAL QUESTION/LEVEL OF EVIDENCE: Therapeutic, IV.