[Functional neurosurgery for spasticity]

Area of Science:

• Neurosurgery
• Neurology
• Physiology

Context:

• Spasticity, characterized by increased stretch reflex activity, significantly impacts patient quality of life.
• Current neurosurgical interventions aim to mitigate this hyperactivity through various targeted approaches.

Purpose:

• To review and compare neurosurgical techniques for spasticity management.
• To highlight the mechanisms and indications for selective peripheral neurotomy, functional posterior rhizotomy, and intrathecal baclofen therapy.

Summary:

• Selective peripheral neurotomy partially resects peripheral motor nerves, including essential Ia afferent nerves, to reduce spasticity, particularly effective for focal spasticity in adults.
• Functional posterior rhizotomy targets posterior rootlets to address abnormal motor responses, primarily in pediatric cerebral palsy.
• Intrathecal baclofen therapy provides a systemic approach for diffuse spasticity by inhibiting alpha motor neuron activity.
• Procedure effectiveness is electrophysiologically monitored via H-reflex (Hmax/Mmax) changes.

Impact:

• Appropriate patient selection based on clinical spasticity features is crucial for achieving favorable clinical outcomes.
• These neurosurgical strategies offer significant potential for improving functional status and quality of life in patients with spasticity.