The surgical treatment of spasticity

Many neurosurgical procedures have been designed for or applied to the trea tment of spasticity arising from different disorders, including cerebral pa lsy; traumatic, ischemic, or hypoxic brain injury, multiple sclerosis, and spinal cord injury. Neurosurgical procedures are primarily aimed at reducin g spasticity by interrupting the stretch reflex at various sites along the spinal reflex are or attempting to increase the centrally mediated inhibito ry influence on the pool of motor neurons in the anterior horn. Surgical in terventions for spasticity can be classified into peripheral ablative proce dures, such as rhizotomy or peripheral neurectomy, and central ablative pro cedures, such as cordectomy, myelotomy, or stereotactic procedures. Non-abl ative procedures include peripheral nerve or motor point blocks, the implan tation of cerebellar or spinal stimulators, and the implantation of subdura l catheters for infusion of pharmacologic agents to increase inhibitory act ivity. Several proposed mechanisms for spasticity are reviewed so that the rationale for the various surgical interventions for spasticity described m ay be better understood. (C) 2000 John Wiley & Sons, Inc.