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The management of paralytic spasticity
D A Herz1, J E Looman, A Tiberio
1Division of Neurosurgery, Michigan State University, Grand Rapids.
Neurosurgery
|February 1, 1990
Summary
For severe paralysis, invasive neurosurgical treatments effectively manage spasticity when medications fail. Procedures like radiofrequency rhizotomy and neurolysis offer high success rates with minimal complications.
Area of Science:
- Neurosurgery
- Rehabilitation Medicine
Background:
- Spasticity in severely paralyzed patients presents a significant neurosurgical challenge.
- Comprehensive management is crucial for patients unresponsive to medical therapy.
Purpose of the Study:
- To evaluate the efficacy and safety of various invasive neurosurgical modalities for treating spasticity in severely paralyzed patients.
Main Methods:
- Percutaneous radiofrequency foraminal rhizotomy (n=77)
- Percutaneous radiofrequency sciatic neurectomy (n=32)
- Myelotomy (n=4)
- Intramuscular neurolysis with phenol injection (n=35)
- Open tenotomies and peripheral neurectomies (n=9)
Main Results:
- Radiofrequency rhizotomy achieved 95% initial success with 5% minor complications.
- Intramuscular neurolysis had an 89% success rate for focal spasticity.
- Myelotomies and open surgical procedures reported complete success without major complications.
Conclusions:
- A range of invasive neurosurgical techniques are available for managing paralytic spasticity.
- These modalities provide effective treatment options when conservative measures are insufficient.
- Multimodal approaches are essential for comprehensive patient care.