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[Spasticity treated with selective posterior rhizotomy].
Marit Grønning1, Frode Svendsen, Håvard Skeidsvoll
1Nevrologisk avdeling, Haukeland Sykehus 5021 Bergen. marit.gronning@haukeland.no
Summary
Selective posterior rhizotomy effectively treated severe spasticity and pain in a multiple sclerosis patient unresponsive to conventional therapies. Surgical intervention offers a viable option for refractory spasticity.
Area of Science:
- Neurosurgery
- Neurology
- Rehabilitation Medicine
Background:
- Spasticity is a common neurological symptom resulting from central nervous system lesions.
- Severe spasticity can significantly impair quality of life and functional mobility.
- Conventional treatments like physiotherapy and medication are not always effective for severe cases.
Observation:
- A case study of a 41-year-old woman with multiple sclerosis (MS) experiencing severe, painful lower limb spasticity.
- The patient's spasticity was refractory to multiple treatments including physiotherapy, spasmolytic drugs, botulinum toxin A, intrathecal baclofen, and epidural spinal cord stimulation.
Findings:
- Selective posterior rhizotomy (S1-L1) was performed, involving sectioning 60% of rootlets on the right and 40% on the left.
- This surgical intervention resulted in significant reduction of spasticity and pain.
- Subsequent tenotomy and myotomy successfully addressed contractures, leading to good functional recovery.
Implications:
- Selective posterior rhizotomy should be considered for patients with severe, painful spasticity refractory to non-surgical treatments.
- Surgical management, specifically posterior rhizotomy, can be a treatment of choice for select patients with debilitating spasticity.
- This case highlights the potential of surgical interventions in managing complex neurological conditions like MS-related spasticity.