The surgical treatment of spasticity.
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.
Smyth
M D
MD
Department of Neurological Surgery, Room M-779, Box 0112, University of California San Francisco, 505 Parnassus Avenue, San Francisco, California 94143-0112, USA. smythm@neuro.ucsf.edu
Peacock
W J
WJ
D004525:Efferent Pathways / Q000503:physiopathology / Q000601:surgery; D006801:Humans; D009128:Muscle Spasticity / Q000503:physiopathology / Q000601:surgery*; D019635:Neurosurgical Procedures