Chemodenervation of muscle(s); neck muscle(s) (eg, for spasmodic torticollis, spasmodic dysphonia)
CPT4 code
Name of the Procedure:
Chemodenervation of Muscle(s) - Neck Muscle(s) (e.g., for Spasmodic Torticollis, Spasmodic Dysphonia)
Summary
Chemodenervation of neck muscles involves using medications like botulinum toxin to temporarily paralyze or weaken overactive or spastic muscles in the neck. This procedure helps relieve symptoms of conditions like spasmodic torticollis (a type of neck dystonia) or spasmodic dysphonia (voice box muscle spasms).
Purpose
The procedure addresses involuntary muscle contractions in the neck and throat that cause abnormal postures, movements, and discomfort. The goal is to reduce muscle spasm, pain, and improve functional movement and quality of life.
Indications
- Spasmodic torticollis (cervical dystonia)
- Spasmodic dysphonia
- Other neck muscle dystonias or spastic conditions
Patients suitable for this procedure often have failed to respond to more conservative treatments like oral medications or physical therapy.
Preparation
- Patients may need to avoid blood thinners and certain medications prior to the procedure.
- No specific fasting required, but individual instructions may vary.
- A diagnostic assessment or imaging studies might be requested to localize affected muscles.
Procedure Description
- The patient is positioned comfortably, typically sitting or lying down.
- The affected neck muscles are identified, often using electromyography (EMG) for precision.
- Botulinum toxin is injected into the targeted muscles using a fine needle.
- The number and location of injections depend on the severity and distribution of muscle spasm.
Local anesthesia or sedation is generally not required, but a numbing agent might be used at the injection site to reduce discomfort.
Duration
The procedure typically takes about 15 to 30 minutes.
Setting
It is usually performed in an outpatient clinic or a physician's office.
Personnel
- A neurologist or a specially trained physician
- Medical assistant or nurse
Risks and Complications
- Minor pain or bruising at injection sites
- Temporary weakness of neck muscles
- Flu-like symptoms, mild headache
- Rarely, difficulty swallowing or breathing if adjacent muscles are affected
Benefits
- Relief of muscle spasm and pain
- Improved neck posture and movement
- Enhanced quality of life Results can often be noticed within a few days and last for several months.
Recovery
- Patients can usually resume normal activities immediately.
- Post-procedure instructions may include avoiding strenuous activity for a day.
- Follow-up appointments are typically scheduled to assess the effectiveness and plan for subsequent treatments.
Alternatives
- Oral medications (e.g., muscle relaxants)
- Physical therapy
- Surgical interventions
- Deep brain stimulation (for severe cases, but less common)
Each alternative has its pros and cons regarding effectiveness, side effects, and invasiveness compared to chemodenervation.
Patient Experience
- Mild discomfort or pain at the injection site during and after the procedure.
- Temporary muscle weakness as the medication takes effect.
- Significant improvement in symptoms can enhance daily functioning and reduce pain. Pain management might include over-the-counter pain relievers if needed.