Ements. Some operations intentionally damage small regions of the thalamus (thalamotomy), globus pallidus (pallidotomy), or other deep centers in the brain. Other surgical approaches include severing one or more of the contracting neck muscles (muscle resection), cutting nerves going to the nerve roots deep in the neck close to the spinal cord (anterior cervical rhizonotomy), and removing the nerves at the point they enter the contracting muscles (selective peripheral denervation). We do not recommend most of these procedures. ordering viagra onlineduihelpqlt.com However, selective peripheral denervation or thalamotomy may be considered in very severe cases when other treatment modalities, including botulinum toxin, have failed and when done be the few neurosurgeons who have significant experience in these specific operations. Botulinum toxin injections botulinum toxin is a toxin produced by bacteria clostridium botulinum. It paralyzes muscles by blocking the impulse transmitted from the nerve endings to the muscles. In very large quantities it can produce fatal paralysis of respiratory muscles. When diluted and given intramuscularly in extremely small quantities, it can give rise to selective paralysis of the injected muscle and is safe. In spasmodic torticollis, the abnormally overactive neck muscles can be identified by clinical examination and palpation. These muscles can be injected with the toxin. Occasionally, an elctromyogram (emg) can confirm or aid in the identification of overactive neck muscles. Studies of this treatment have been shown to produ.