Destructive
procedures for ST aim to interrupt the neural pathways thought to be
responsible for the neck spasms. Some believe that hyperactivity of
the basal ganglia cause Spasmodic Torticollis (ST), and therefore focus
injuries upon the thalamus (thalamotomy) or globus pallidus (pallidotomy).
Alternatively, surgical attention may be directed at the individual
muscles, either by severing or removing them, (myotomy)
or cutting their nerve supply. The nerve injury procedures include rhizotomies
of the upper anterior nerve roots or accessory nerve rootlets, as well
as selective peripheral denervation. This latter procedure aims to only
interrupt nerve branches to affected neck muscles, while preserving
normal muscle activity.
These procedures have shown moderate to
very good success rates, but ST patients usually only resort to them
when their symptoms have become severe and unresponsive to other therapies.
This is because of the invasive and permanent nature of these destructive
procedures. Risks of potential complications must also be considered,
including the loss of muscle control, muscle atrophy and neck deformity,
instability, the continued presence of pain, and the possible spread
of ST to different muscles.
Unfortunately, no treatment approach is
effective for all patients with ST. Therefore, careful consultation
with experienced neurologists and neurosurgeons is important in formulating
a management plan.
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