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Surgical treatment of painful spasticity after spinal cord injury
A Livshits1, Z H Rappaport, V Livshits
1Spinal Care Unit, Meir General Hospital, Kfar-Sava, Israel.
Study Design:
There are several conservative methods of painful spasticity treatment. However, conservative methods do not always provide long-term and complete antispastic effects in cases of spinal cord injury with severe painful spasticity.
Objectives:
The aim of the present study was to analyse and compare the effectiveness of myelotomy by Bischof II and Pourpre in patients with paraplegia and severe painful spasticity in the late period after spinal cord trauma.
Setting:
Spinal Care Unit, Meir General Hospital, Israel.
Methods:
Twenty patients had longitudinal T-myelotomy by the Bischof II technique and 20 longitudinal myelotomy en croix (Pourpre). The spasticity was determined by evaluated muscle tone and muscle spasm according to the Ashworth and spasm-frequency scales. The pain was determined by McGill short questionnaire. The results were calculated by the Wilcoxon signed rank test, by Mann-Whitney U-test and Students t-test. Clinical outcomes after myelotomy in-patients with chronic spinal cord injury and painful spasticity were evaluated after 6 months, 5 and 10 year follow-up period.
Results:
Pain was relieved in all cases. The best motor antispastic effect was achieved after Pourpre myelotomy in 18 of the patients (90%) were evaluated after a follow-up of 6 months, 15 patients (75%) after 5 years, and 11 patients (64.7%) after 10 years. Following Bischof II myelotomy results were classified as good: in 13 patients-(65%) at 6 months; in nine patients (45%) at 5 years and in six patients-(40%) at 10 years. Statistical analysis showed no reliable relationship between the level of Spinal cord lesion (T4-T10) and the type of operation. No instability occurred as a result of antispastic operation in any patient.
Conclusion:
A higher rate of beneficial outcome was achieved after Pourpre myelotomy. We recommend this operation for patients with paraplegia and painful spasticity, who do not have hope of regaining voluntary motor function. However, transections of basic pathways of spasticity are not always sufficient for complete antispastic effects. Good results after the operation may deteriorate in time. Therefore further investigations into the mechanism of the spasticity syndrome in the spinal cord injured patient are required.
