Selective Denervation and Resection of Cervical Muscles in the Treatment of Spasmodic Torticollis: Long-Term Follow-Up Results in 207 Cases

Abstract

Object: To report the outcome of patients with selective denervation and resection of cervical muscles for spasmodic torticollis. Methods: We reviewed 362 cases of surgically treated spasmodic torticollis. 207 patients were followed from 2 years to 29 years. Results: Total or marked relief of symptoms with preservation of normal of nearly normal movements has been obtained in 87.9%. Conclusion: This procedure may be recommended if one to two years of conservative therapy does not offer satisfactory relief of symptoms.

Dystonia and Peripheral Nerve Surgery in the Cervical Area

“…Resection of dystonic muscles is occasionally combined with selective peripheral denervation (Albanese et al, 2006;Bronte-Stewart, 2003;Chen et al, 2000;Huh et al, 2005;Krauss, 2010;Münchau et al, 2001a;Xingkang, 1981). In the authors view, muscle section is an adjunctive procedure for cervical dystonia and should be considered in cases with longstanding dystonia which exhibit evidence of soft tissue stiffness or muscle shortening.…”

“…Good surgical candidates for the operation include those who meet the following parameters (Braun et al, 1995;Brin & Benabou, 1999;Chen et al, 2000;Dashtipour et al, 2007;Feely, 2003 Furthermore, selective peripheral denervation is sometimes considered as a major alternative to botulinum toxin injection in the treatment of cervical dystonia. For example, for patients who do not require multiple repeated injections or who cannot afford the cost of the toxin, the operation is meaningful for them (Taira, 2009).…”

“…Surgical options for cervical dystonia are listed in Table 4 (Bertrand, 1993;Braun & Richter, 2002;Brin & Benabou, 1999;Chen et al, 2000;Huh et al, 2005Huh et al, , 2010Münchau et al, 2001a;. Selective peripheral denervation is not a good alternative for anterocollis because extensive bilateral denervation of both superficial and deep anterior cervical muscles can lead to significant disabling anterior neck muscle paresis and swallowing dysfunction.…”

“…Some of them were unvalidated and employed subjective methods whereas the remaining studies used widely accepted and validated measure tools, such as the TWSTRS or Tsui score. Overall therapeutic outcomes of selective peripheral denervation are displayed in Table 5 (Bertrand, 1993;Braun et al, 2002;Chen et al, 2000;Cohen-Gadol et al, 2003;Huh et al, 2005Huh et al, , 2010Jang et al, 2005;Meyer, 2001;Münchau et al, 2001a;Nunta-aree et al, 2010a;Sitthinamsuwan et al, 2010b;. Fig.…”

Reduction of Cervical Dystonia After an Extended Course of Chiropractic Manipulation: A Case Report

“…24 Conservative treatments requiring months or even years are not uncommon. 25 Neuromuscular blockade using botulism toxin is emerging as the most viable conservative treatment option. 22,[26][27][28] Unfortunately, like other treatments of CD, this is palliative and must be repeated, as the blockade wears off in several weeks to months.…”