Name of the Procedure:

Chemodenervation of muscle(s); neck muscle(s), excluding muscles of the larynx, unilateral (e.g., for cervical dystonia, spasmodic torticollis).

Summary

Chemodenervation is a procedure that involves injecting a substance, often botulinum toxin, into the muscles of the neck to temporarily paralyze or weaken them. This helps reduce abnormal muscle contractions and relieve pain associated with conditions like cervical dystonia or spasmodic torticollis.

Purpose

Chemodenervation is used to treat abnormal muscle contractions in the neck (cervical dystonia), a condition where the neck muscles contract involuntarily, causing the head to twist or turn to one side. The procedure aims to alleviate pain and improve range of motion and head positioning.

Indications

• Cervical dystonia
• Spasmodic torticollis
• Chronic neck pain due to muscle spasms

Patient criteria include:

• Diagnosis of muscle spasm-related conditions
• No significant contraindications for botulinum toxin
• Unresponsive to other conservative treatments

Preparation

• Patients may be advised to avoid blood-thinning medications a few days prior.
• No specific fasting required, but follow doctor's instructions.
• Physical examination and possibly imaging studies to map the muscles to be treated.

Procedure Description

1. The patient is positioned comfortably, usually sitting or lying down.
2. The skin over the treatment area is cleansed.
3. Using electromyography (EMG) guidance, the physician identifies the overactive muscles.
4. Small injections of botulinum toxin are administered directly into the target muscles.
5. The process is typically performed without general anesthesia; local anesthetic may be used.

Duration

The procedure usually takes about 15-30 minutes.

Setting

Performed in an outpatient clinic or doctor's office.

Personnel

• Physician (e.g., neurologist, anesthesiologist, or specialist in physical medicine and rehabilitation)
• Nurse or medical assistant

Risks and Complications

• Temporary pain at the injection site
• Difficulty swallowing or speaking if adjacent muscles are affected
• Mild flu-like symptoms
• Rarely, spread of toxin effects beyond the intended treatment area (e.g., muscle weakness)

Benefits

• Reduction in muscle contractions and pain
• Improvement in head posture and range of motion
• Results typically seen within a few days to a week and can last several months

Recovery

• Patients can usually resume normal activities immediately
• Avoid strenuous activities for 24 hours post-injection
• Follow-up appointment may be scheduled to assess effectiveness and plan future treatments

Alternatives

• Oral medications such as muscle relaxants or anticholinergics
• Physical therapy
• Surgical intervention in severe cases
• Each alternative has its own risks and benefits to be discussed with a healthcare provider

Patient Experience

• Patients may feel a slight pinch or discomfort during the injections.
• Mild soreness or bruising at the injection site is common.
• Pain management includes over-the-counter pain relief if necessary.
• Most patients experience significant relief from symptoms and improvement in quality of life.