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.