The National Institute for Health and Clinical Excellence (NICE) has issued full guidance to the NHS in England, Wales, Scotland and Northern Ireland on selective peripheral denervation for cervical dystonia.


Cervical dystonia is a condition in which the muscles of the neck contract painfully and cause twisting of the head. It may be congenital, but may also occur at any age. Cervical dystonia may persist for several years, and sometimes for life. About 20% of people will recover without treatment.

Cervical dystonia varies according to which muscle groups are affected. The head may be pulled backwards (retrocollis), forwards (anterocollis) or to the side (torticollis).

The cause of cervical dystonia is not known. In children, it is sometimes associated with congenital abnormalities of head shape or spine.

Standard treatment for cervical dystonia includes physiotherapy, drugs to reduce spasm, injections of botulinum toxin and brain surgery. Peripheral denervation has been advocated as an alternative, especially in people who have not responded to other treatments.

Selective peripheral denervation is a surgical approach which involves cutting the nerves to the muscles of the neck through a large skin incision. The surgery is carried out under general anaesthetic. The procedure varies according to the muscle groups affected, and whether it involves cutting of the muscles.

Coding and clinical classification codes for this guidance.

Your responsibility

This guidance represents the view of NICE, arrived at after careful consideration of the evidence available. When exercising their judgement, healthcare professionals are expected to take this guidance fully into account, and specifically any special arrangements relating to the introduction of new interventional procedures. The guidance does not override the individual responsibility of healthcare professionals to make decisions appropriate to the circumstances of the individual patient, in consultation with the patient and/or guardian or carer. 

All problems (adverse events) related to a medicine or medical device used for treatment or in a procedure should be reported to the Medicines and Healthcare products Regulatory Agency using the Yellow Card Scheme.

Commissioners and/or providers have a responsibility to implement the guidance, in their local context, in light of their duties to have due regard to the need to eliminate unlawful discrimination, advance equality of opportunity, and foster good relations. Nothing in this guidance should be interpreted in a way that would be inconsistent with compliance with those duties. Providers should ensure that governance structures are in place to review, authorise and monitor the introduction of new devices and procedures.

Commissioners and providers have a responsibility to promote an environmentally sustainable health and care system and should assess and reduce the environmental impact of implementing NICE recommendations wherever possible.