Spasticity
Spasticity is involuntary muscle stiffness caused by abnormal signaling between the brain, spinal cord, and muscles. It can affect one or many muscle groups and can lead to pain, abnormal posture, and difficulty with movement.
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Spasticity is best managed by a multidisciplinary team.
Non-surgical treatment:
• Physical and occupational therapy to reduce muscle contraction and improve function
• Bracing and splinting
• Medications — baclofen, gabapentin, benzodiazepines, dantrolene sodium, or tizanidine
• Botox injections into affected muscles to reduce contractions
Surgical treatment:
For severe spasticity that doesn't respond to conservative care, surgical options include:
• Intrathecal baclofen pump — delivers medication directly to the space around the spinal cord
• Selective dorsal rhizotomy — selective cutting of nerve rootlets at the spinal cord to reduce overactivity
• Selective neurotomy — for focal spasticity, the motor nerve branches to the affected muscle are selectively cut
• Muscle lengthening
• Tendon transfers
These procedures are generally safe and effective for severe, refractory spasticity. Patients typically go home the day after surgery with oral pain medication and return for follow-up within a few days.