Surgical management of spasticity

doi:10.1017/CBO9780511544866.012

11 - Surgical management of spasticity

Published online by Cambridge University Press: 22 August 2009

Patrick Mertens and

Marc Sindou

Edited by

Michael P. Barnes and

Garth R. Johnson

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Patrick Mertens: Affiliation:
Professor of Neurosurgery Hôpital Neurologique et Neuro-Chirurgical Pierre Wertheimer, Lyon, France
Marc Sindou: Affiliation:
Professor of Neurosurgery Hôpital Neurologique et Neuro-Chirurgical Pierre Wertheimer, Lyon, France
Michael P. Barnes: Affiliation:
University of Newcastle upon Tyne
Garth R. Johnson: Affiliation:
University of Newcastle upon Tyne

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Summary

Introduction

Spasticity is one of the commonest sequelae of neurological diseases. In most patients spasticity is useful in compensating for lost motor strength. Nevertheless, in a significant number of patients it may become excessive and harmful, leading to further functional losses. When not controllable by physical therapy, medications and/or botulinum toxin injections, spasticity can benefit from neurostimulation, intrathecal pharmacotherapy or selective ablative procedures.

Neuro-stimulation procedures

Stimulation of the spinal cord was developed in the 1970s on the basis of the ‘gate-control theory’ of Melzach and Wall (1974) for the treatment of neurogenic pain. This method has been found to be partially effective in the treatment of spastic syndromes, such as those encountered in multiple sclerosis (Cook & Weinstein, 1973; Gybels & Van Roost, 1987) or spinal cord degenerative diseases, such as Strumpell–Lorrain syndrome. However, this method is generally most effective when spasticity is mild and the dorsal column has sufficient functional fibres, as assessed by somatosensory evoked potentials. Stimulation electrodes are implanted, either percutaneously through a Tuohy needle under X-ray fluoroscopy or surgically via an open interlaminar approach in the extradural space posteriorly to the dorsal column, at the level of the thoracolumbar spinal cord for spasticity in the lower limbs of paraparetic patients or at the level of the cervical spinal cord for spasticity in the upper and/or lower limbs of quadriparetic patients.

Keywords

muscle tendon assembly neurological diseases orthopaedic procedures sclerosis spinal cord spasticity Strumpell-Lorrain syndrome spastic syndromes

Type: Chapter
Information: Upper Motor Neurone Syndrome and Spasticity
Clinical Management and Neurophysiology
, pp. 193 - 213

DOI: https://doi.org/10.1017/CBO9780511544866.012 [Opens in a new window]

Publisher: Cambridge University Press

Print publication year: 2008

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11 - Surgical management of spasticity

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