Microsurgical denervation in treatment of focal cervical muscular dystonia: 72 cases analysis

Abstract

Objective: To analyze the results of microsurgical denervation in spasmodic torticollis patients. Materials and methods: 72 patients with spasmodic torticollis were enrolled into the study. All enrolled patients underwent 154 microsurgical denervations of dystonic muscles, including 58 selective denervations of sternocleidomastoid muscle, 66 selective posterior ramisectomy of C1-C6 rootlets (Bertrand’s procedure), 30 denervations and myotomias of dystonic muscles of omo-trapezoid triangle (DMOTT). The outcome evaluation was conducted via neurological examination and Toronto Western Spasmodic Torticollis Rating Scale questionnaire. Results: Initial number of severe torticollis patients was 25 (34.72%), moderate severity – 40 (55.55%), mild severity – 7 (9.72%), during the analysis of long-term outcomes – 0 (0%), 38 (57.57%) and 28 (42.42%) respectively. Initial severe disability was in 44 patients (61.11%), moderate – in 25 (34.72%), mild – in 3 (4.16% ) patients, during the analysis of long-term outcomes – in 3 (4.54%), 34 (51.51%) and 29 (43.93%) patients respectively. Conclusions: Average index of good outcomes, which included morbid severity and disability severity, was 64.39%. In 35.61% of patients the outcomes of treatment were less satisfactory due to presence of residual pathological movements, neuralgia of occipital nerve, disesthesia in C2 dermatome, transient weakness of trapezoid muscle.