The surgical treatment of spasticity

The surgical treatment of spasticity has been aimed at four different levels: the brain, the spinal cord, peripheral nerves, and the muscle. Stereotactic neurosurgery, whether involving the globus pallidum, ventrothalamic nuclei, or the cerebellum, has had little success. Cerebellar pacemakers have been tried: results have been mixed but not ultimately encouraging. Selective posterior rhizotomy is currently the most widely used and effective central nervous system procedure. Posterior rootlets in L2-S2 are exposed and tested with electrical stimulation. Those showing abnormal response are transected. Contraindications include weakness and marked fixed contracture. Neurectomy has been tried for spasticity, but the results have not been encouraging and the adverse effects may be severe. Musculoskeletal surgery remains an important procedure for treatment of contractures secondary to spasticity.