Neurosurgical Options for Treatment of Spasticity

(these options are not offered by South Shore Neurologic)

diagram of selective posterior rhizotomy:

 

Surgical Techniques in the Treatment of Spasticity

• Stereotactic neurosurgery with temperature-controlled electrocoagulation is not currently warranted in the treatment of spasticity.
  • Procedure: Stereotactic Encephalotomy
    • Target: globus pallidus, ventrolateral thalamic nucleui, cerebellum
    • Results: variable to poor
• Nonspecific cerebellar stimulation has no proven role in the treatment of spasticity, though further refinements may eventually change this.
• Longitudinal myelotomy of the cunus medullaris is designed to interrupt the spinal reflex arc between the anterior and posterior horns within the spinal cord. It is a technically difficult operation with significant morbidity.
• Selective posterior rhizotomy involves nerve roots from L2 to S2. Usually between 1/4 and 1/2 of all nerve rootlets tested are cut.
  • Temporary, occasionally complete anesthesia or dysesthesias may occur, though these may be overcome by overlap among adjacent dermatomes
  • Weakness is an important contraindication to rhizotomy
  • There is no way to gauge how effective this procedure will be until the neurodestructive surgery has been completed
  • Once done, rhizotomy is not reversible
  • The limited efficacy studies of SPR have been encouraging, though not entirely conclusive
• There is little role for surgical neurectomy in spasticity management.
• Musculoskeletal surgery is common, though its effects on spasticity are variable and unpredictable.
  • Tendon cutting surgery does not treat spasticity but its consequences
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