gms | German Medical Science

Objective: Dystonia is a hyperkinetic movement disorder characterized by involuntary and sustained contractions of opposing muscles that result in twisting movements and abnormal postures. Dystonia is often disabling and can have a significant impact on physical and psychosocial well-being. There are several medical therapeutic options available, but none have been proven to be efficient, with the exception of the botulinum neurotoxin injection in cases of cervical dystonia (CD). Different surgical procedures have also been used in CD, including ablative and non-ablative techniques; these include myotomy, neurotomy, rhizotomy, and thalamic and pallidal ablation or stimulation. Although non-ablative techniques have recently been shown to be safe and effective, ablative procedures are still favoured in some cases. In the present study, we report our experience with multiple cervical motor rhizotomy (the so-called Dandy-McKenzie technique) for the treatment of CD.

Method: Twenty-four patients (13 males and 11 females) with severe spasmodic torticollis accompanied by cervical pain underwent unilateral motor rhizotomy of C1-C4 and contralateral C1-C3, as well as bilateral accessory nerve neurotomy (Dandy-McKenzie technique). In 7 patients, a neurotomy of the extra-spinal accessory nerve was also performed to treat residual dystonia, and in another 3 patients, percutaneous radiofrequency facial nerve neurotomy was performed for the treatment of facial dyskinesia (Meige’s Syndrome).

Results: In 21 cases, results were satisfactory (TWSTRS > 3), with all patients but one reporting pain relief. All patients reported transitory dysphagia, but with complete recovery 3 months after the procedure. Two patients presented temporary gait instability. No major complications were observed.

Conclusions: This is a safe, simple, efficient and inexpensive procedure for the treatment of CD and should be considered in cases where non-ablative surgery is inappropriate.