Rehabilitative neurosurgery.
The neurosurgical role in rehabilitation rehabilitation was studied. Over a 5-year period, 850 individuals were referred to a rehabilitation center after initial acute care. Surgery was indicated for 66 patients. There were 28 quadriplegic or paraplegic individuals with intractable spasticity. Percutaneous radiofrequency foramenal rhizotomies were found to be 98% effective in relieving posttraumatic spasticity. In 14 patients with cognitive impairment, intellectual improvement had reached a plateau level. These persons underwent computed tomography scanning and cisternography, revealing significant communicating hydrocephalus. After surgical shunt therapy, cognitive improvement was noted in 86%. Nineteen individuals were sent for rehabilitation following spine fracture or progressive quadriplegia; 17 were found to have persistent spinal instability requiring surgical stabilization by fusion. This was successful in all cases without complications. Two persons required decompressive spinal operations, resulting in neurological stabilization or improvement. Five patients developed pain, spasticity, ascending neurological deficit, or autonomic dysreflexia due to posttraumatic syrinx. These symptoms were stabilized or improved following syringosubarachnoid shunting. The authors submit that comprehensive neurosurgical reevaluation is desirable in patients received for rehabilitation. Periodic neurosurgical follow-up is recommended. The neurosurgeon's role is not limited to the acute process.
D A
DA
Herz
M
M
Gregerson
L
L
Pearl
D001927:Brain Diseases / Q000534:rehabilitation*; D002557:Cerebrospinal Fluid Shunts; D003131:Combined Modality Therapy; D005593:Fracture Fixation, Internal; D006801:Humans; D006849:Hydrocephalus / Q000534:rehabilitation; D007796:Laminectomy; D009128:Muscle Spasticity / Q000534:rehabilitation; D019965:Neurocognitive Disorders / Q000534:rehabilitation; D010264:Paraplegia / Q000534:rehabilitation; D010348:Patient Care Team; D011782:Quadriplegia / Q000534:rehabilitation; D013118:Spinal Cord Diseases / Q000534:rehabilitation*; D013119:Spinal Cord Injuries / Q000601:surgery; D013122:Spinal Diseases / Q000534:rehabilitation*; D013123:Spinal Fusion; D013124:Spinal Injuries / Q000601:surgery; D013126:Spinal Nerve Roots / Q000601:surgery; D013595:Syringomyelia / Q000534:rehabilitation