Management of generalized spasticity of lower limbs by selective posterior rhizotomy
AbstractIntroduction: Spasticity can be defined as a velocity-dependent resistance to passive movement of a joint and its associated musculature. Functional neurosurgery should be considered when spasticity cannot be controlled by physical therapy and medications.
Objective: This study was done to evaluate the functional results of microsurgical DREZotomy (MDT) in a consecutive series of 15 paraplegic patients suffered from generalized spasticity of lower limbs.
Methods: This retrospective study included 15 paraplegic patients (10 due to spinal cord injury and 5 due to disseminated sclerosis) who underwent MDT for treatment of spasticity. The male to female ratio was 2–1 (10 males and 5 females) and their ages ranged from 22 to 56 years with mean age of 39 years. Assessment of spasticity was done using modified Ashworth scale and global functional score. All cases underwent MDT that consisted of a longitudinal incision of the dorsolateral sulcus, performed ventrolaterally at the entrance of the rootlets into the sulcus, followed by bipolar coagulations performed inside the sulcus, down to the apex of the dorsal horn, continuously along all the spinal cord segments selected for surgery. Mean postoperative follow up examination period was 30 months. Results: There was no operative mortality. Postoperatively, all the patients had improvement of their spasticity grade. Assessment of outcome after surgery was done by comparing global functional score for spastic paraplegic patients before and after surgery. At the last follow up examination period, excellent results were obtained in 33.3% of patients, good results in 60% of patients, and fair results in 6.7% of patients.
Conclusion: MDT typically had a dramatic effect on tone in lower limbs. Better long-term results were obtained in the spastic patients caused by spinal cord injury (excellent results in 40%) than in the spasticity caused by disseminated sclerosis (excellent results in 20%).