Spasticity is a serious consequence of various forms of paralysis that may be congenital or may arise from situations such as premature birth or various accidents. Spasticity can be manifested by increased muscle tone, stiffness, contraction, pain, impaired motor development, bone and joint deformities, all of which limit the ability to move. Spasticity is also a serious impediment to physiotherapy and recovery programs. Under these conditions, one of the challenges of the neurology and neurosurgery departments is also the treatment of spasticity. Nowadays, there are several methods including botulinum toxin injections, selective neurotomia (an intervention that occurs at the level of the nerves that innervate certain spastic muscles, and thus the muscles receive fewer nerve signals and reduce spasticity) and the implantation of a pump for baclofen (an effective medicine) in the spinal cord that can reduce impulses and abnormal stimulation, reducing spasticity. Another established method for treating spasticity is selective dorsal rhizotomy by expert teams, one of which is led by Prof. Dr. Ilhan Elmaci with ACIBADEM Maslak Hospital.
“This is a very special intervention that is recommended for patients with certain forms of cerebral palsy or after some trauma. These are accompanied by spasticity, which occurs as a result of damage to nerve circuits between the brain and the extremities. And the solution can be selective dorsal rhizotomy, surgery in the cervical or dorsal area, and selective isolation of motor nerves or responsible for the transmission of nerve impulses to the brain. Thus, we interrupt certain nerve circuits responsible for spasticity. After this intervention, patients can recover much better by physiotherapy. We have a study group that includes neurologists, neurosurgeons and physiotherapists who decide on the cases in which this intervention can be done. After surgery, patients continue their recovery programs for 6 months. If we estimate intervention will not help patients, we don’t do it”, says the expert from ACIBADEM.
Selective dorsal rhizotomy can be done in both adults and children after the age of 2 years. Selection of candidates for selective dorsal rhizotomy is made after a thorough assessment of the situation by teams of neurosurgeons, neurologists, orthopedists and physical therapists.
“If we find that spasticity is getting worse, as happens with diplexia or spastic paraparesis affecting lower limbs, then these patients may be candidates for selective dorsal rhizotomy. If a patient has tetraplegia that affects both the upper and lower limbs, then he may be a candidate for a selective dorsal rhizotomy in the cervical area. We want to solve the painful spasticity that prevents patients from effectively doing recovery programs. Practically, we open the way to physiotherapy, this is the goal of selective dorsal rhizotomy”, concludes Prof. Dr. Ilhan Elmaci with ACIBADEM Maslak Hospital.