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11 - Surgical management of spasticity

Published online by Cambridge University Press:  22 August 2009

By
Patrick Mertens  and
Marc Sindou
Edited by
Michael P. Barnes  and
Garth R. Johnson
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 assemblyneurological diseasesorthopaedic proceduressclerosisspinal cordspasticityStrumpell-Lorrain syndromespastic syndromes
Type
Chapter
Information
Upper Motor Neurone Syndrome and Spasticity
Clinical Management and Neurophysiology
 , pp. 193 - 213
Publisher: Cambridge University Press
Print publication year: 2008

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  • Surgical management of spasticity
    • By Patrick Mertens, Professor of Neurosurgery Hôpital Neurologique et Neuro-Chirurgical Pierre Wertheimer, Lyon, France, Marc Sindou, Professor of Neurosurgery Hôpital Neurologique et Neuro-Chirurgical Pierre Wertheimer, Lyon, France
  • Edited by Michael P. Barnes, University of Newcastle upon Tyne, Garth R. Johnson, University of Newcastle upon Tyne
  • Book: Upper Motor Neurone Syndrome and Spasticity
  • Online publication: 22 August 2009
  • Chapter DOI: https://doi.org/10.1017/CBO9780511544866.012
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To save content items to your account, please confirm that you agree to abide by our usage policies. If this is the first time you use this feature, you will be asked to authorise Cambridge Core to connect with your account. Find out more about saving content to Dropbox.

  • Surgical management of spasticity
    • By Patrick Mertens, Professor of Neurosurgery Hôpital Neurologique et Neuro-Chirurgical Pierre Wertheimer, Lyon, France, Marc Sindou, Professor of Neurosurgery Hôpital Neurologique et Neuro-Chirurgical Pierre Wertheimer, Lyon, France
  • Edited by Michael P. Barnes, University of Newcastle upon Tyne, Garth R. Johnson, University of Newcastle upon Tyne
  • Book: Upper Motor Neurone Syndrome and Spasticity
  • Online publication: 22 August 2009
  • Chapter DOI: https://doi.org/10.1017/CBO9780511544866.012
Available formats
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To save content items to your account, please confirm that you agree to abide by our usage policies. If this is the first time you use this feature, you will be asked to authorise Cambridge Core to connect with your account. Find out more about saving content to Google Drive.

  • Surgical management of spasticity
    • By Patrick Mertens, Professor of Neurosurgery Hôpital Neurologique et Neuro-Chirurgical Pierre Wertheimer, Lyon, France, Marc Sindou, Professor of Neurosurgery Hôpital Neurologique et Neuro-Chirurgical Pierre Wertheimer, Lyon, France
  • Edited by Michael P. Barnes, University of Newcastle upon Tyne, Garth R. Johnson, University of Newcastle upon Tyne
  • Book: Upper Motor Neurone Syndrome and Spasticity
  • Online publication: 22 August 2009
  • Chapter DOI: https://doi.org/10.1017/CBO9780511544866.012
Available formats
×