A Novel Denervation Procedure for Idiopathic Cervical Dystonia

Abstract

Background: For idiopathic cervical dystonia, the treatment of choice is botulinum toxin injection or surgical denervation. There are two major procedures of surgical denervation: intradural ventral rhizotomy and extradural peripheral neurotomy (Bertrand procedure). The Bertrand procedure is always accompanied by popstoperative sensory loss in the C2 region. Methods: The authors have modified these procedures to minimize the complications. Our method is unilateral intradural ventral rhizotomy of C1 and C2, extradural denervation of the C3–C6 posterior rami and contralateral peripheral sectioning of the branches of the accessory nerve to the sternocleidomastoid muscle. Forty-four patients underwent this modified operation (‘Taira’s’ method: group A) and the results were compared with those in a matched control group of 38 patients who underwent the traditional Bertrand’s procedure (Bertrand’s method: group B). Results: Three patients in group A showed a sensory deficit in the C2 area, while all of the patients in group B had C2 sensory disturbance. Pre- and postoperative rating scores did not differ between the two groups. The intraoperative blood loss was significantly smaller in group A. Conclusion: Compared with the traditional Bertrand’s operation, our procedure carries a much lower incidence of complications and a significant decrease of intraoperative blood loss.