Surgical treatment of painful spasticity after spinal cord injury

Abstract

Study design: There are several conservative methods of painful spasticity treatment. However, conservative methods do not always provide long-term and complete antispastic e ects in cases of spinal cord injury with severe painful spasticity. Objectives: The aim of the present study was to analyse and compare the e ectiveness of myelotomy by Bischof II and Pourpre in patients with paraplegia and severe painful spasticity in the late period after spinal cord trauma. Setting: Spinal Care Unit, Meir General Hospital, Israel. Methods: Twenty patients had longitudinal T-myelotomy by the Bischof II technique and 20 longitudinal myelotomy en croix (Pourpre). The spasticity was determined by evaluated muscle tone and muscle spasm according to the Ashworth and spasm ± frequency scales. The pain was determined by McGill short questionnaire. The results were calculated by the Wilcoxon signed rank test, by Mann ± Whitney U-test and Students t-test. Clinical outcomes after myelotomy in-patients with chronic spinal cord injury and painful spasticity were evaluated after 6 months, 5 and 10 year follow-up period. Results: Pain was relieved in all cases. The best motor antispastic e ect was achieved after Pourpre myelotomy in 18 of the patients (90%) were evaluated after a follow-up of 6 months, 15 patients (75%) after 5 years, and 11 patients (64.7%) after 10 years. Following Bischof II myelotomy results were classi®ed as good: in 13 patients ± (65%) at 6 months; in nine patients (45%) at 5 years and in six patients ± (40%) at 10 years. Statistical analysis showed no reliable relationship between the level of Spinal cord lesion (T4-T10) and the type of operation. No instability occurred as a result of antispastic operation in any patient. Conclusion: A higher rate of bene®cial outcome was achieved after Pourpre myelotomy. We recommend this operation for patients with paraplegia and painful spasticity, who do not have hope of regaining voluntary motor function. However, transections of basic pathways of spasticity are not always su cient for complete antispastic e ects. Good results after the operation may deteriorate in time. Therefore further investigations into the mechanism of the spasticity syndrome in the spinal cord injured patient are required.

Spinal cord stimulation for chronic pain of neuropathic or ischaemic origin: systematic review and economic evaluation

“…Unfortunately, the costs from the PROCESS trial 115 neurologist, orthopaedic surgeon and followup during trial (nurse) costs. The investigation cost consists of computed tomography, magnetic resonance imaging, radiography and myelography.…”

<p>Botulinum Toxin Type A Possibly Affects Ca_v3.2 Calcium Channel Subunit in Rats with Spinal Cord Injury-Induced Muscle Spasticity</p>

“…16 Contusion was induced on laminectomized animals and muscle spasticity was determined by evaluating muscle tone and muscle spasm according to the Ashworth and spasm–frequency scales. 25 Post-operative care was performed including manually assisted extrusion and analgesia. BoT-A Botox was diluted with 2 mL of saline and a solution was prepared with 6 U of toxin per 0.1 mL.…”

Rehabilitation of Spinal Cord Injury: WFNS Spine Committee Recommendations

“…Livshits et al 72 report in a case-control study comparing the Pourpre versus Bischof II approaches and assesses the effectiveness of reducing pain and refractory spasticity in patients with SCI (N = 40), the follow-up at 6 months, 5 and 10 years using the McGill Pain Questionnaire, the current intensity scale of the pain and the visual analogue scale (VAS) to assess control and improvement of pain, found that both techniques are effective for this purpose, however, with more significant results with the Pourpre technique. 72 There is level 3 evidence from a case-control study to support the use of longitudinal myelotomy to decrease spasticity with pain in patients with SCI. 72,73 The main indications for myelotomy are in patients with abdominal or pelvic visceral pain secondary to cancer.…”

“…72 There is level 3 evidence from a case-control study to support the use of longitudinal myelotomy to decrease spasticity with pain in patients with SCI. 72,73 The main indications for myelotomy are in patients with abdominal or pelvic visceral pain secondary to cancer.…”