{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,6,18]],"date-time":"2026-06-18T14:56:02Z","timestamp":1781794562176,"version":"3.54.5"},"reference-count":50,"publisher":"Journal of Neurosurgery Publishing Group (JNSPG)","issue":"5","content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":[],"published-print":{"date-parts":[[2026,5,1]]},"abstract":"<jats:sec>\n                    <jats:title>OBJECTIVE<\/jats:title>\n                    <jats:p>Cervical dystonia (CD) is the most common focal dystonia, characterized by abnormal head postures and pain, often refractory to botulinum toxin therapy. Selective peripheral denervation (SPD) remains a key surgical option, but long-term outcomes in large cohorts are underreported. The purpose of this study was to evaluate the long-term outcomes of SPD in patients with botulinum toxin\u2013refractory CD, focusing on symptom severity, pain, and head posture improvement.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>METHODS<\/jats:title>\n                    <jats:p>This retrospective study included 160 adults (mean \u00b1 SD age 54 \u00b1 12.0 years, 46% male) with refractory CD who underwent SPD at a single center by a single surgeon from January 2005 to July 2023. Outcomes were assessed using subjective clinical measures and the Toronto Western Spasmodic Torticollis Rating Scale (TWSTRS), which was calculated retrospectively from clinical records. The modified Bertrand technique involved selective denervation and myotomies tailored to each patient\u2019s dystonic pattern. TWSTRS scores were analyzed at baseline, 3 months, 1 year, and final follow-up (mean \u00b1 SD 10.3 \u00b1 9.0 months). Time to minimal clinically important difference (MCID) (\u2265 12-point TWSTRS drop) was evaluated with covariate-adjusted Kaplan-Meier modeling (ever vs never revised, evaluated with the log-rank test) and a counting-process Cox model with revision as a time-dependent covariate.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>RESULTS<\/jats:title>\n                    <jats:p>Among 160 patients (mean follow-up duration 21.6 \u00b1 35.6 months), TWSTRS improved by 73.5% at 3 months and 61.3% at last follow-up (p &lt; 0.001). Median time to MCID was 3.0 months for never revised patients versus 22.0 months for ever revised patients (log-rank chi-square statistic = 19.09, p &lt; 0.0001). In a time-dependent Cox model, revision surgery was significantly associated with higher likelihood of achieving MCID (HR 2.31, p &lt; 0.005). Pain relief and improved head posture were reported in over 50% of patients. Complications were minimal, and recurrence was observed in 4.2% of cases. Outcomes were consistent with or exceeded those reported in the literature with either SPD or deep brain stimulation (DBS).<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>CONCLUSIONS<\/jats:title>\n                    <jats:p>SPD is an effective and durable surgical option for refractory CD, significantly improving pain, posture, and quality of life. Although revision surgery delayed time to improvement, it significantly increased the likelihood of achieving meaningful clinical improvement. Overall efficacy aligns with the existing literature, reinforcing its role as a first-line surgical intervention. Further studies should explore strategies to enhance long-term outcomes and delineate the role of SPD relative to DBS.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.3171\/2025.8.jns2592","type":"journal-article","created":{"date-parts":[[2026,1,22]],"date-time":"2026-01-22T12:00:25Z","timestamp":1769083225000},"page":"1154-1162","source":"Crossref","is-referenced-by-count":0,"title":["Selective peripheral denervation for refractory cervical dystonia: a single-center retrospective analysis of 160 cases"],"prefix":"10.3171","volume":"144","author":[{"given":"Damiano G.","family":"Barone","sequence":"first","affiliation":[{"name":"Department of Neurosurgery, Houston Methodist Hospital, Houston, Texas;"},{"name":"Department of Neurosurgery, Mayo Clinic, Rochester, Minnesota"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Ken","family":"Porche","sequence":"additional","affiliation":[{"name":"Department of Neurosurgery, Mayo Clinic, Rochester, Minnesota"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Kirsten M.","family":"Hayford","sequence":"additional","affiliation":[{"name":"Department of Neurosurgery, Mayo Clinic, Rochester, Minnesota"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Robert J.","family":"Spinner","sequence":"additional","affiliation":[{"name":"Department of Neurosurgery, Mayo Clinic, Rochester, Minnesota"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"1754","reference":[{"issue":"13","key":"b1","series-title":"Drugs","first-page":"1921","article-title":"Cervical dystonia: pathophysiology and treatment options","volume":"61","author":"Velickovic M","year":"2001","unstructured":"Velickovic M, Benabou R, Brin MF. Cervical dystonia: pathophysiology and treatment options. Drugs. 2001;61(13):1921\u20131943."},{"key":"b2","series-title":"International Review of Neurobiology","first-page":"573","article-title":"Surgical treatment of dystonia","volume":"98","author":"Yianni J","year":"2011","unstructured":"Yianni J, Green AL, Aziz TZ. Surgical treatment of dystonia. In: International Review of Neurobiology. Vol 98. Elsevier;2011:573-589."},{"issue":"1","key":"b3","series-title":"Eur J Neurol","first-page":"5","article-title":"EFNS guidelines on diagnosis and treatment of primary dystonias","volume":"18","author":"Albanese A","year":"2011","unstructured":"Albanese A, Asmus F, Bhatia KP,  EFNS guidelines on diagnosis and treatment of primary dystonias. Eur J Neurol. 2011;18(1):5\u201318."},{"key":"b4","series-title":"Toxicon","first-page":"89","article-title":"Longitudinal studies of botulinum toxin in cervical dystonia: why do patients discontinue therapy?","volume":"147","author":"Jinnah HA","year":"2018","unstructured":"Jinnah HA, Comella CL, Perlmutter J, Lungu C, Hallett M. Longitudinal studies of botulinum toxin in cervical dystonia: why do patients discontinue therapy? Toxicon. 2018;147:89\u201395."},{"issue":"4","key":"b5","series-title":"Mov Disord Clin Pract","first-page":"541","article-title":"Management of secondary poor response to botulinum toxin in cervical dystonia: a multicenter audit","volume":"8","author":"Tucker H","year":"2021","unstructured":"Tucker H, Osei-Poku F, Ashton D,  Management of secondary poor response to botulinum toxin in cervical dystonia: a multicenter audit. Mov Disord Clin Pract. 2021;8(4):541\u2013545."},{"issue":"Suppl 1","key":"b6","series-title":"Eur J Neurol","first-page":"97","article-title":"Surgical treatment of dystonia","volume":"17","author":"Krauss JK","year":"2010","unstructured":"Krauss JK. Surgical treatment of dystonia. Eur J Neurol. 2010;17 Suppl 1:97\u2013101."},{"issue":"2","key":"b7","series-title":"Surg Neurol","first-page":"96","article-title":"Selective peripheral denervation for spasmodic torticollis: surgical technique, results, and observations in 260 cases","volume":"40","author":"Bertrand CM","year":"1993","unstructured":"Bertrand CM. Selective peripheral denervation for spasmodic torticollis: surgical technique, results, and observations in 260 cases. Surg Neurol. 1993;40(2):96\u2013103."},{"issue":"12","key":"b8","series-title":"J Neurol Neurosurg Psychiatry","first-page":"1307","article-title":"Selective peripheral denervation for cervical dystonia: long-term follow-up","volume":"86","author":"Bergenheim AT","year":"2015","unstructured":"Bergenheim AT, Nordh E, Larsson E, Hariz MI. Selective peripheral denervation for cervical dystonia: long-term follow-up. J Neurol Neurosurg Psychiatry. 2015;86(12):1307\u20131313."},{"issue":"2","key":"b9","series-title":"Expert Opin Pharmacother","first-page":"129","article-title":"The management of cervical dystonia","volume":"8","author":"Ferreira JJ","year":"2007","unstructured":"Ferreira JJ, Costa J, Coelho M, Sampaio C. The management of cervical dystonia. Expert Opin Pharmacother. 2007;8(2):129\u2013140."},{"issue":"Pt 11","key":"b10","series-title":"Brain","first-page":"2879","article-title":"The Canadian multicentre study of deep brain stimulation for cervical dystonia","volume":"130","author":"Kiss ZHT","year":"2007","unstructured":"Kiss ZHT, Doig-Beyaert K, Eliasziw M, Tsui J, Haffenden A, Suchowersky O. The Canadian multicentre study of deep brain stimulation for cervical dystonia. Brain. 2007;130(Pt 11):2879\u20132886."},{"issue":"5","key":"b11","series-title":"J Neurol Neurosurg Psychiatry","first-page":"642","article-title":"Symptomatic and functional outcome of surgical treatment of cervical dystonia","volume":"63","author":"Krauss JK","year":"1997","unstructured":"Krauss JK, Toups EG, Jankovic J, Grossman RG. Symptomatic and functional outcome of surgical treatment of cervical dystonia. 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Mov Disord. 2012;27(2):301\u2013304."},{"issue":"1-4","key":"b14","series-title":"Stereotact Funct Neurosurg","first-page":"44","article-title":"Outcome of selective peripheral denervation for cervical dystonia","volume":"77","author":"Meyer CHA","year":"2001","unstructured":"Meyer CHA. Outcome of selective peripheral denervation for cervical dystonia. Stereotact Funct Neurosurg. 2001;77(1-4):44\u201347."},{"issue":"5","key":"b15","series-title":"Oper Neurosurg","first-page":"546","article-title":"Selective cervical denervation for cervical dystonia: modification of the Bertrand procedure","volume":"14","author":"Wilson TJ","year":"2018","unstructured":"Wilson TJ, Spinner RJ. Selective cervical denervation for cervical dystonia: modification of the Bertrand procedure. Oper Neurosurg. 2018;14(5):546\u2013555."},{"issue":"1","key":"b16","series-title":"Neurosurg Focus Video","first-page":"V3","article-title":"Selective denervation for cervical dystonia","volume":"8","author":"Bauman MMJ","year":"2023","unstructured":"Bauman MMJ, Lakomkin N, Spinner RJ. Selective denervation for cervical dystonia. Neurosurg Focus Video. 2023;8(1):V3."},{"key":"b17","series-title":"J Neurosci Methods","first-page":"108750","article-title":"Deep brain stimulation in dystonia: state of art and future directions","volume":"340","author":"Macerollo A","year":"2020","unstructured":"Macerollo A, Sajin V, Bonello M,  Deep brain stimulation in dystonia: state of art and future directions. 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Neurosurgery. 2010;67(4):957\u2013963."},{"issue":"6","key":"b20","series-title":"J Neurosurg","first-page":"1247","article-title":"Selective peripheral denervation for the treatment of intractable spasmodic torticollis: experience with 168 patients at the Mayo Clinic","volume":"98","author":"Cohen-Gadol AA","year":"2003","unstructured":"Cohen-Gadol AA, Ahlskog JE, Matsumoto JY, Swenson MA, McClelland RL, Davis DH. Selective peripheral denervation for the treatment of intractable spasmodic torticollis: experience with 168 patients at the Mayo Clinic. 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Brain. 2001;124(4):769\u2013783."},{"issue":"3","key":"b23","series-title":"Acta Neurochir (Wien)","first-page":"435","article-title":"Effectiveness of selective peripheral denervation in combination with pallidal deep brain stimulation for the treatment of cervical dystonia","volume":"157","author":"Chung M","year":"2015","unstructured":"Chung M, Han I, Chung SS, Jang DK, Huh R. Effectiveness of selective peripheral denervation in combination with pallidal deep brain stimulation for the treatment of cervical dystonia. Acta Neurochir (Wien). 2015;157(3):435\u2013442."},{"issue":"9","key":"b24","series-title":"Lancet Neurol","first-page":"875","article-title":"Pallidal neurostimulation in patients with medication-refractory cervical dystonia: a randomised, sham-controlled trial","volume":"13","author":"Volkmann J","year":"2014","unstructured":"Volkmann J, Mueller J, Deuschl G,  Pallidal neurostimulation in patients with medication-refractory cervical dystonia: a randomised, sham-controlled trial. Lancet Neurol. 2014;13(9):875\u2013884."},{"key":"b25","series-title":"World Neurosurg","first-page":"728.e1","article-title":"Bilateral pallidotomy for cervical dystonia after failed selective peripheral denervation","volume":"89","author":"Horisawa S","year":"2016","unstructured":"Horisawa S, Goto S, Takeda N, Terashima H, Kawamata T, Taira T. Bilateral pallidotomy for cervical dystonia after failed selective peripheral denervation. World Neurosurg. 2016;89:728.e1\u2013728.e4."},{"issue":"13","key":"b1","series-title":"Drugs","first-page":"1921","article-title":"Cervical dystonia: pathophysiology and treatment options","volume":"61","author":"Velickovic M","year":"2001","unstructured":"Velickovic M, Benabou R, Brin MF. Cervical dystonia: pathophysiology and treatment options. Drugs. 2001;61(13):1921\u20131943."},{"key":"b2","series-title":"International Review of Neurobiology","first-page":"573","article-title":"Surgical treatment of dystonia","volume":"98","author":"Yianni J","year":"2011","unstructured":"Yianni J, Green AL, Aziz TZ. Surgical treatment of dystonia. In: International Review of Neurobiology. Vol 98. Elsevier;2011:573-589."},{"issue":"1","key":"b3","series-title":"Eur J Neurol","first-page":"5","article-title":"EFNS guidelines on diagnosis and treatment of primary dystonias","volume":"18","author":"Albanese A","year":"2011","unstructured":"Albanese A, Asmus F, Bhatia KP,  EFNS guidelines on diagnosis and treatment of primary dystonias. Eur J Neurol. 2011;18(1):5\u201318."},{"key":"b4","series-title":"Toxicon","first-page":"89","article-title":"Longitudinal studies of botulinum toxin in cervical dystonia: why do patients discontinue therapy?","volume":"147","author":"Jinnah HA","year":"2018","unstructured":"Jinnah HA, Comella CL, Perlmutter J, Lungu C, Hallett M. Longitudinal studies of botulinum toxin in cervical dystonia: why do patients discontinue therapy? Toxicon. 2018;147:89\u201395."},{"issue":"4","key":"b5","series-title":"Mov Disord Clin Pract","first-page":"541","article-title":"Management of secondary poor response to botulinum toxin in cervical dystonia: a multicenter audit","volume":"8","author":"Tucker H","year":"2021","unstructured":"Tucker H, Osei-Poku F, Ashton D,  Management of secondary poor response to botulinum toxin in cervical dystonia: a multicenter audit. Mov Disord Clin Pract. 2021;8(4):541\u2013545."},{"issue":"Suppl 1","key":"b6","series-title":"Eur J Neurol","first-page":"97","article-title":"Surgical treatment of dystonia","volume":"17","author":"Krauss JK","year":"2010","unstructured":"Krauss JK. Surgical treatment of dystonia. Eur J Neurol. 2010;17 Suppl 1:97\u2013101."},{"issue":"2","key":"b7","series-title":"Surg Neurol","first-page":"96","article-title":"Selective peripheral denervation for spasmodic torticollis: surgical technique, results, and observations in 260 cases","volume":"40","author":"Bertrand CM","year":"1993","unstructured":"Bertrand CM. Selective peripheral denervation for spasmodic torticollis: surgical technique, results, and observations in 260 cases. Surg Neurol. 1993;40(2):96\u2013103."},{"issue":"12","key":"b8","series-title":"J Neurol Neurosurg Psychiatry","first-page":"1307","article-title":"Selective peripheral denervation for cervical dystonia: long-term follow-up","volume":"86","author":"Bergenheim AT","year":"2015","unstructured":"Bergenheim AT, Nordh E, Larsson E, Hariz MI. Selective peripheral denervation for cervical dystonia: long-term follow-up. 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J Neurol. 2014;261(2):300\u2013308."},{"issue":"2","key":"b13","series-title":"Mov Disord","first-page":"301","article-title":"Bilateral deep brain stimulation for cervical dystonia in patients with previous peripheral surgery","volume":"27","author":"Capelle HH","year":"2012","unstructured":"Capelle HH, Blahak C, Schrader C,  Bilateral deep brain stimulation for cervical dystonia in patients with previous peripheral surgery. Mov Disord. 2012;27(2):301\u2013304."},{"issue":"1-4","key":"b14","series-title":"Stereotact Funct Neurosurg","first-page":"44","article-title":"Outcome of selective peripheral denervation for cervical dystonia","volume":"77","author":"Meyer CHA","year":"2001","unstructured":"Meyer CHA. Outcome of selective peripheral denervation for cervical dystonia. Stereotact Funct Neurosurg. 2001;77(1-4):44\u201347."},{"issue":"5","key":"b15","series-title":"Oper Neurosurg","first-page":"546","article-title":"Selective cervical denervation for cervical dystonia: modification of the Bertrand procedure","volume":"14","author":"Wilson TJ","year":"2018","unstructured":"Wilson TJ, Spinner RJ. Selective cervical denervation for cervical dystonia: modification of the Bertrand procedure. Oper Neurosurg. 2018;14(5):546\u2013555."},{"issue":"1","key":"b16","series-title":"Neurosurg Focus Video","first-page":"V3","article-title":"Selective denervation for cervical dystonia","volume":"8","author":"Bauman MMJ","year":"2023","unstructured":"Bauman MMJ, Lakomkin N, Spinner RJ. Selective denervation for cervical dystonia. Neurosurg Focus Video. 2023;8(1):V3."},{"key":"b17","series-title":"J Neurosci Methods","first-page":"108750","article-title":"Deep brain stimulation in dystonia: state of art and future directions","volume":"340","author":"Macerollo A","year":"2020","unstructured":"Macerollo A, Sajin V, Bonello M,  Deep brain stimulation in dystonia: state of art and future directions. J Neurosci Methods. 2020;340:108750."},{"key":"b18","series-title":"World Neurosurg","first-page":"e940","article-title":"Deep brain stimulation versus peripheral denervation for cervical dystonia: a systematic review and meta-analysis","volume":"122","author":"Ravindran K","year":"2019","unstructured":"Ravindran K, Ganesh Kumar N, Englot DJ, Wilson TJ, Zuckerman SL. Deep brain stimulation versus peripheral denervation for cervical dystonia: a systematic review and meta-analysis. World Neurosurg. 2019;122:e940\u2013e946."},{"issue":"4","key":"b19","series-title":"Neurosurgery","first-page":"957","article-title":"Bilateral deep brain stimulation for cervical dystonia: long-term outcome in a series of 10 patients","volume":"67","author":"Cacciola F","year":"2010","unstructured":"Cacciola F, Farah JO, Eldridge PR, Byrne P, Varma TK. Bilateral deep brain stimulation for cervical dystonia: long-term outcome in a series of 10 patients. Neurosurgery. 2010;67(4):957\u2013963."},{"issue":"6","key":"b20","series-title":"J Neurosurg","first-page":"1247","article-title":"Selective peripheral denervation for the treatment of intractable spasmodic torticollis: experience with 168 patients at the Mayo Clinic","volume":"98","author":"Cohen-Gadol AA","year":"2003","unstructured":"Cohen-Gadol AA, Ahlskog JE, Matsumoto JY, Swenson MA, McClelland RL, Davis DH. Selective peripheral denervation for the treatment of intractable spasmodic torticollis: experience with 168 patients at the Mayo Clinic. J Neurosurg. 2003;98(6):1247\u20131254."},{"issue":"3","key":"b21","series-title":"Acta Neurochir (Wien)","first-page":"427","article-title":"Selective peripheral denervation for the treatment of spasmodic torticollis: long-term follow-up results from 648 patients","volume":"157","author":"Wang J","year":"2015","unstructured":"Wang J, Li J, Han L,  Selective peripheral denervation for the treatment of spasmodic torticollis: long-term follow-up results from 648 patients. Acta Neurochir (Wien). 2015;157(3):427\u2013433."},{"issue":"4","key":"b22","series-title":"Brain","first-page":"769","article-title":"Prospective study of selective peripheral denervation for botulinum-toxin resistant patients with cervical dystonia","volume":"124","author":"Munchau A","year":"2001","unstructured":"Munchau A. Prospective study of selective peripheral denervation for botulinum-toxin resistant patients with cervical dystonia. Brain. 2001;124(4):769\u2013783."},{"issue":"3","key":"b23","series-title":"Acta Neurochir (Wien)","first-page":"435","article-title":"Effectiveness of selective peripheral denervation in combination with pallidal deep brain stimulation for the treatment of cervical dystonia","volume":"157","author":"Chung M","year":"2015","unstructured":"Chung M, Han I, Chung SS, Jang DK, Huh R. Effectiveness of selective peripheral denervation in combination with pallidal deep brain stimulation for the treatment of cervical dystonia. 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