Selective peripheral denervation for the treatment of spasmodic torticollis

The results of selective peripheral denervation in 50 patients with spasmodic torticollis are presented. Of our patients, 76% reported a significant improvement or disappearance of their dystonia. The mean follow-up is 25 months. There were no major side effects. We recommend the procedure to patients who primarily have responded to botulinum toxin therapy and had become secondary nonresponders or to those refusing further injections while still responding. The results are much less promising in patients who are primary nonresponders to botulinum toxin. Some remarkable histological findings are presented. The posterior branches of the cervical roots frequently showed signs of severe compression neuropathy. In three cases, a functional motor nerve regeneration was proved. Among all surgical options, selective peripheral denervation provides the best result and has the fewest side effects.