Role of selective peripheral denervation in management of refractory cervical dystonia

Abstract

Background
Selective peripheral denervation (SPD) technique has been highly considered in the neurosurgical practice for refractory cervical dystonia (CD) management for many years. The present study evaluated the outcomes of SPD in the treatment of refractory CD.


Methods
Between May 2021 and August 2024, 15 patients with cervical dystonia (CD) were treated with botulinum toxin injections in our Neurosurgery Department. Only four of them showed a significant response. The remaining 11 patients were classified as secondary non-responders and underwent surgical treatment with SPD and were prospectively followed for one year after surgery. All patients were evaluated at the Neurosurgery, Neurology and Physical Medicine, Rheumatology, and Rehabilitation Departments, Tanta University Hospitals. All cases underwent preoperative, postoperative evaluation of CD severity with the Modified Tsui score and visual analogue score (VAS), neurological examination, and sonographic examinations.


Results
All patients (2 males and 9 females, with a mean age of 35.9 ± 8.5 years) showed an immediate postoperative improvement in dystonic symptoms, based on the modified Tsui scale, with the exception of head tremors. Head tremors demonstrated significant delayed improvement in 72.7% of patients by the final follow-up, while 27.3% continued to experience mild tremors and require further follow-up. The VAS scores demonstrated significant pain improvement at both follow-up intervals: 6 months and 1 year.


Conclusions
The outcomes of our selective peripheral denervation approach for treating refractory cervical dystonia unresponsive to botulinum toxin have been promising, providing durable, excellent results with minimal adverse events like C2 distribution dysesthesias and wound infection.