When the basic treatments are unsatisfactory, some patients benefit from denervation surgery. The objective of the surgery is to selectively remove muscle motor nerves that actuate 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 significantly reduced pain. The success rate for this surgery is high, which is fortunate because it is irreversible.
The surgery 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 needed to minimize chances of dystonia recurring after surgery.
- Dystonic symptoms are primarily in the cervical region. Some patients have dystonia extending into the shoulder, back, or other locations where surgical procedures are difficult or not well developed. The highest probability for success is with accessible nerves in cervical muscles.
- The best results are for cases involving pure rotation torticollis. Good results can also often be achieved with pure laterocollis (head pulling to the left or right) and laterocollis combined with rotary torticollis. Poorer results are obtained with retrocollis (head pulled to the rear) and anteriocollis (head pulled forward).
Maximum benefit from surgery is obtained with post-operative physical therapy. Muscle therapy enables the patient to quickly acclimatize to the modified neuro-muscular situation and enjoy the benefits of the surgery.