The novel assessment tool for scoring of functional outcomes after surgical release in congenital muscular torticollis

Abstract

© 2018, Siriraj Medical Journal. Objective: Congenital muscular torticollis, characterized by unilateral shortening of the sternocleidomastoid muscle that results in the head tilting towards the affected side, is the third most common musculoskeletal anomaly. Subjective assessment using the Lee scoring system has been the most common method for evaluating the surgical outcomes. The aim of this study was to investigate the efficacy of a novel assessment tool for scoring of functional outcomes after surgical release in congenital muscular torticollis. Methods: This study enrolled the patients aged 5-15 years who were diagnosed with congenital muscular torticollis and treated by surgical release at the Department of Orthopaedic Surgery, Faculty of Medicine Siriraj Hospital, Mahidol University, Bangkok, Thailand during 1998-2011. An image processing program was used to measure all evaluated parameters. Craniofacial asymmetry, neck rotation deficits, neck flexion/extension deficits, and degree of head-tilting were graded as poor, fair, good, or excellent by 2 observers. The results of the Lee scoring system and the new scoring system were then compared. Results: Nineteen patients (7 males, 12 females) with a mean age of 7.2±2.57 years were included. Photographs of the patients were evaluated and categorized by outcome score using both outcome scoring systems. All intraclass correlation coefficients were higher than 0.6 for both scoring systems, which suggests good inter-operator reliability (p < 0.05). Percentage agreement was higher in the new system than in the Lee system (63.16% vs. 52.63%, respectively). Conclusion: The new outcome scoring system which focuses on functional outcomes after surgical release was found to be less subjective and more reliable than the Lee scoring system.