MICROSURGICAL DREZOTOMY FOR THE TREATMENT OF HARMFUL SPASTICITY IN THE LOWER-LIMBS

Citation
P. Mertens et M. Sindou, MICROSURGICAL DREZOTOMY FOR THE TREATMENT OF HARMFUL SPASTICITY IN THE LOWER-LIMBS, Neuro-chirurgie, 44(3), 1998, pp. 209-218
Citations number
23
Categorie Soggetti
Surgery,"Clinical Neurology
Journal title
ISSN journal
00283770
Volume
44
Issue
3
Year of publication
1998
Pages
209 - 218
Database
ISI
SICI code
0028-3770(1998)44:3<209:MDFTTO>2.0.ZU;2-H
Abstract
Ablative functional neurosurgery can be useful in some selected patien ts for the treatment of harmful spasticity in the lower limbs. Microsu rgical drezotomy was introduced in 1972, on the basis of anatomical st udies of the human dorsal root entry zone (DREZ) showing a topographic al segregation of the afferent fibers according to their size and thus functional destinations. It consists of a 3 mm deep microsurgical les ion directed at a 45 degree angle in the postero-lateral sulcus, penet rating the DREZ in its ventro-lateral aspect, at the level of all the rootlets considered as involved in spasticity (and pain). It destroys mainly the lateral (nociceptive) and central (myotatic) afferent fiber s as well as the facilitatory medial part of the Lissauer tract, whils t sparing most of the medial (lemniscal) fibers and the inhibitor late ral part of the Lissauer tract. We report a series of 121 bedridden pa tients suffering: from harmful spasticity in one (15) or both (106) lo wer limbs and treated with microsurgical drezotomy. Surgery was decide d on because of abnormal postures in flexion in two-thirds of the pati ents and in hyperextension in one-third, additional pain in 75 of them , and hyperactive bladder in 38 cases. The post-operative results were evaluated after a mean follow-up time of 5 years and 6 months. Both s pasticity and spasms were significantly decreased or suppressed respec tively in 78 % and 88 % of the patients. When present, pain was reliev ed without abolition of sensation in 82 %. These benefits resulted in either disappearance or marked reduction of the abnormal postures and articular limitation in 90 % of the patients. When present preoperativ ely, urinary leakage disappeared in 85 % of the cases Mild to severe c omplications occurred in 32 patients and precipirated or were responsi ble for death in 6 cases (5 %). This is explained by the fact that mos t of the patients, especially those affected by multiple sclerosis, we re in very precarious general and neurological conditions. Microsurgic al drezotomy has however enabled a large majoritory of these severely disabled patients to sit and lie comfortably. and allowed them to reac h a significantly improved quality of life.