The surgical treatment of spasticity

Abstract

Many neurosurgical procedures have been designed for or applied to the treatment of spasticity arising from different disorders, including cerebral palsy; traumatic, ischemic, or hypoxic brain injury, multiple sclerosis, and spinal cord injury. Neurosurgical procedures are primarily aimed at reducing spasticity by interrupting the stretch reflex at various sites along the spinal reflex arc or attempting to increase the centrally mediated inhibitory influence on the pool of motor neurons in the anterior horn. Surgical interventions for spasticity can be classified into peripheral ablative procedures, such as rhizotomy or peripheral neurectomy, and central ablative procedures, such as cordectomy, myelotomy, or stereotactic procedures. Non‐ablative procedures include peripheral nerve or motor point blocks, the implantation of cerebellar or spinal stimulators, and the implantation of subdural catheters for infusion of pharmacologic agents to increase inhibitory activity. Several proposed mechanisms for spasticity are reviewed so that the rationale for the various surgical interventions for spasticity described may be better understood. © 2000 John Wiley & Sons, Inc. Muscle Nerve 23: 153–163, 2000.

Evidence for the efficacy and effectiveness of THC-CBD oromucosal spray in symptom management of patients with spasticity due to multiple sclerosis

“…Invasive medication like intrathecal baclofen pumps for resistant spasticity [Smyth and Peacock, 2000] or intramuscular injections of botulinum toxin A for focal cases [Kabus et al 2006] are used only for a small number of patients. Few patients are treated with intrathecal triamcinolone-acetonide [Kamin et al 2014].…”

Modification of spasticity by transcutaneous spinal cord stimulation in individuals with incomplete spinal cord injury

“…5,6 Yet, therapeutic control of severe forms of spasticity, while maintaining or even enhancing residual motor capacities, has remained difficult. 7 Surgical treatment of spasticity is based on the concept that spinal reflex circuitry becomes hyperactive after being deprived of supraspinal inhibitory control. By cutting the posterior roots, Otfrid Foerster, in 1909, interrupted afferent inputs to the spinal cord to reduce the excitability of segmental neural circuits.…”

Radiation-Induced Spinal Cord Anaplastic Astrocytoma Subsequent to Radiotherapy for Testicular Seminoma

“…7) Cordectomy is advocated as a reasonable alternative treatment for spinal malignant astrocytoma presenting with complete deficit below the lesion, 6,9,12) for the treatment of pain, spasticity, and posttraumatic syringomyelia. 10,20,22) The effects of cordectomy for spinal malignant astrocytoma with remaining function below the lesion are unknown. To perform cordectomy in such cases, the patients need to accept complete deficits below the lesion and decreased quality of life after cordectomy.…”