Cervical Rhizotomy (Selective Peripheral Denervation)

It is indicated in patients with cervical dystonia/torticollis who do not achieve adequate response with medical treatment or repeated botulinum injections or those who are non-responders to botulinum injections. Selective peripheral denervation is now accepted as the best surgical option for these patients. Overall, about one to two-thirds of patients achieve long-term improvement. It is not indicated in patients who have symptoms like blepharospasm and laryngeal spasm in addition to cervical dystonia.

In this procedure, nerves supplying the affected muscles of the neck are selectively cut. In peripheral denervation for torticollis, a small incision is given at back of neck. Nerves outside the spinal canal, which are going to the affected muscles, are first identified and stimulated under Neurophysiologic guidance and then they are cut. Each nerve is carefully identified and resected under microscope; in this way only the affected muscles are denervated without damaging any important structures. We confirm the adequacy of denervation with the help of signals recorded from each muscle before and after the resection of the nerves.

This procedure is done under general anesthesia and hence there is no discomfort to the patient. Once denervated, the patient is turned on his back and the front of the neck is prepared. One of the muscles which is responsible for torticollis is sternocleidomastoid in the neck. So, one more small incision is taken in neck and nerve going to this muscle is selectively cut. Similarly, the nerve supplying the muscle which is responsible for elevation of shoulder in torticollis is selectively cut. As the whole procedure is done under Neurophysiological monitoring, the results are extremely good. The total duration of hospital stay is around 6-7 days.

After selective peripheral denervation for spasmodic torticollis, it is very important that patients do posture exercises to regain a sense of midline and to improve the range of movement. Although a denervation procedure for torticollis is not a curative treatment the overall improvement of the symptoms is generally 80–90%.