Overview

Selective denervation (SD) is a surgical operation that involves cutting through the nerves that control the overactive muscles causing the symptoms of dystonia. By cutting off the nerve supply, the tightening should stop in the muscles. It is called ‘selective’ denervation to indicate that not all muscles are cut, only the ones identified as being affected by the dystonia.

Process

The operation is done through an opening made in the skin and is carried out under general anaesthetic. The procedure varies depending on which of your muscle groups are affected and whether they need to be cut. You will also need to complete physiotherapy sessions after the procedure to build up strength in your neck.

Suitability

SD is used mainly for dystonia of the neck (cervical dystonia/spasmodic torticollis). It is usually used when botulinum toxin treatment has been tried and has failed or is starting to fail. It might not be possible if your neck dystonia involves numerous muscle groups as it would involve cutting too many nerves, some of which you need to preserve movement. The best results are usually in cases of a rotation or twist in the neck.

Benefits

• If you are suitable, there is a reasonable chance of eliminating the effects of dystonia and in other cases there is often a significant improvement in body position
• You may not require other treatments (except for physio) following the procedure

Risks

All surgical procedures carry a degree of risk both from the surgery and the introduction of anaesthesia.

There have also been cases that included the following side effects:

• Temporary swallowing problems – in extremely rare cases this can become permanent
• Numb patches at the back of the head if sensation nerves are cut
• Twitching pain in the neck
• Abscess (pus-filled swelling) in the throat
• Swelling in the neck
• Pins and needles or a feeling of tightness or fullness in the neck

Success

Success rates for SD vary between individual cases. You should discuss this fully with your clinician.

Access

Referral for SD will be made by a consultant specialising in movement disorders. To get the procedure approved, they will need to confirm that you are a suitable candidate.
The procedure is funded by the NHS however there are only a few neurosurgeons performing this type of operation in the UK as the demand is relatively low.