What are the advantages and the disadvantages of having surgery to treat spasticity ?
When not controllable by physical therapy, oral or intrathecal medications and/or botulinum toxin injections, spasticity symptoms can be treated with selective ablative procedures. In most cases, complementary neurosurgical and functional orthopedic approaches are used.
With surgical interventions, muscles can be denervated or tendons and muscles can be released, lengthened, or transferred to relieve the symptoms of spasticity. In practice, only 5% of spasticity patients undergo a surgical intervention.
By orthopedic surgery, muscles can be denervated, and tendons and muscles can be released, lengthened, or transferred. In order to release contractures, the contracted tendon is partially or completely split surgically and then the joint is repositioned at a more normal angle. A cast stabilizes the joint over a period of several weeks while the tendon regrows. After removing the cast, physical therapy is necessary to strengthen the muscles and improve the patient’s range of motion.
Surgical intervention that is used for the treatment of spasticity is called functional or selective dorsal rhizotomy (SDR). In this procedure, the neurosurgeon cuts nerve roots (rhizotomy) – the nerve fibers lying just outside the back bone (spinal column) that send sensory messages from the muscles to the spinal cord. ‘Selective’ indicates that only certain nerve roots are cut, and ‘dorsal’ refers to the target nerves that are located at the back of the spinal cord (the upper surface when a person is lying on his or her stomach).