ABSTRACT
Spasmodic torticollis is the most common form of adult-onset focal dystonia (1). This syndrome is characterized by deviation of the neck due to involuntary contraction of cervical muscles. There may also be spasmodic features such as head jerking or neck spasms. These, however, only manifest in approximately 62% of patients and have led some to use the more accurate term idiopathic cervical dystonia (2). Other forms of torticollis, as well as the possibility of secondary dystonia, must be excluded before arriving at this diagnosis. While its exact etiology is still unclear, there has been much progress in clarifying its clinical features, natural history, genetic predisposition, and association with trauma and vestibular abnormalities. The goals of treatment are to improve the quality of life and prevent secondary complications. Chemodenervation of the involved musculature with botulinum toxin has proven effective in treating this condition. Some patients do not respond well or become resistant to botulinum toxin and require surgical intervention. The most commonly performed surgery is the Bertrand procedure of selective peripheral denervation (3). Refractory cases may be amenable to deep brain stimulation (DBS) or neuroablation. The aim of this chapter is primarily to discuss the surgical indications as well as some of the surgical techniques used in treating this debilitating condition.
