When basic treatments are unsatisfactory, some patients benefit from denervation surgery. The purpose of the surgery is to selectively remove muscle motor nerves that activate affected muscles.
The nerves selected for removal are those that carry the unwanted contraction signals. The result is improved muscle behavior, more normal posture and markedly reduced pain. The success rate of this operation is high, which is fortunate because it is irreversible.
The operation is expensive and there is some risk, so doctors select patients carefully. Typically, the criteria are as follows:
- Previous treatments no longer provide significant benefits.
- .The patient’s clinical situation has been stable for at least one year and the condition has existed for at least several years. Symptom stability is necessary to minimize the chances of recurrent dystonia after surgery.
- Dystonic symptoms are primarily in the cervical region. Some patients have dystonia that extends into the shoulder, back, or other places where surgical procedures are difficult or not well developed. The highest probability of success is with accessible nerves in the cervical muscles.
- The best results are for cases involving pure rotational torticollis. Good results can also often be obtained with pure laterocollis (the head pulls to the left or right) and laterocollis combined with rotating torticollis. Worse results are obtained with retrocollis (head pulled back) and anteriocollis (head pulled forward).
Maximum benefit from surgery is achieved with post-operative physiotherapy. Muscle therapy allows the patient to quickly acclimatize to the modified neuro-muscular situation and enjoy the benefits of the operation.
