Surgical Treatment for Spasticity: Selective Dorsal Rhizotomy – Technique and Literature Review

Abstract

Spasticity is a motor disorder that leads to a resistance to passive joint movement. Cerebral palsy is the most important cause of spasticity and can be caused by several factors, including multiple gestations, alcoholism, infections, hemorrhages, drowning, and traumatic brain injuries, among others. There are many scales that help to measure and monitor the degree of impairment of these patients. The initial treatment should focus on the causal factor, such as tumors, inflammation, degenerative diseases, hydrocephalus, etc. Subsequently, the treatment of spastic musculature includes oral or intrathecal myorelaxants, spinal cord electrostimulation, neurotomies, Lissauer tract lesion, dentatotomy and selective dorsal rhizotomy. The latter is a safe technique, possible to be performed in most centers with neurosurgical support, and it is effective in the treatment of severe spasticity. In this article, the authors describe the surgical technique and conduct a review the literature.

Resumo

A espasticidade é um distúrbio motor que leva a um quadro de resistência ao movimento articular passivo. A paralisia cerebral é a mais importante causa de espasticidade e pode ser causada por diversos fatores, tais como gestações múltiplas, alcoolismo, infecções, hemorragias, afogamento, lesões cerebrais traumáticas, entre outros. Existem muitas escalas que ajudam a mensurar e acompanhar o grau de acometimento desses pacientes. O tratamento inicial deve focar no fator causal, como tumores, inflamação, doenças degenerativas, hidrocefalia etc. Posteriormente, o tratamento da musculatura espástica inclui miorrelaxantes orais, intratecais, eletroestimulação medular, neurotomias, lesão do trato de Lissauer, dentatotomia e a rizotomia dorsal seletiva. Esta última é uma técnica segura, possível de ser realizada na maioria dos centros com suporte neurocirúrgico, e eficaz no tratamento da espasticidade grave. No presente, artigo, os autores descrevem a técnica cirúrgica e fazem uma revisão da literatura.

Keywords

spasticity - rhizotomy - cerebral palsy - electrical stimulation - surgery

Palavras-chave

espasticidade - rizotomia - paralisia cerebral - monitorização intraoperatória - cirurgia

Publikationsverlauf

Eingereicht: 27. Oktober 2017

Angenommen: 04. Dezember 2017

Artikel online veröffentlicht:
10. Mai 2018

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