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All Posts Tagged: Paraplegia

Contemporary Treatment of Spasticity

 

 

Under normal circumstances, our muscles are in a state of a partly continuous contraction. This normal phenomenon is called muscle tone and is necessary for our body to maintain its natural posture, as well as to keep our muscles in a state of readiness when we want to perform a movement. The control of this system is done against our will (subconsciously) and is subject to multiple regulatory mechanisms of our nervous system.

Spasticity is a form of muscle tone disorder in which there is excessive muscle contraction, to the point that even people with near normal muscle strength, find it impossible to perform voluntary movements smoothly. Diseases such as cerebral palsy, traumatic brain injury, spinal cord injuries (injury, tumors, ischemic damages) can cause spasticity. Other conditions such as multiple sclerosis and other neurodegenerative conditions are also causes of spasticity. In addition to the obstruction of the harmonious movement of the muscles, there are also muscular pains as well as disturbance of the physical posture of the body due to hypertonia. These factors have a very negative effect on the quality of life of the patients.

Modern neurosurgical methods

In the treatment of patients with spasticity physicians and physiotherapists specialised in rehabilitation should be involved. The modern neurosurgical approach plays an important role in the treatment of these patients. Unfortunately, both patients and their families, as well as therapists, are often unaware of the existence of modern neurosurgical methods that can dramatically improve in many cases the life and functionality of these patients.

Therefore, providing all the necessary information to the individuals concerned and their families is an important parameter.

Thespastikotita1 Oral medication, administered by the treating physician (usually a neurologist) is often effective but is sometimes insufficient or accompanied by systemic side effects. A more modern method is the intrathecal baclofen injection. Baclofen is a powerful muscle relaxant. Pump administration constitutes a significant innovation in the treatment of spasticity because even a very small dose (1% of the oral dose) is effective in reducing spasticity. Pump placement surgery is a simple operation lasting about 30 minutes, under general anesthesia. The pump can then be operated for years, delivering the required dose to the nearest millimeter, on a 24-hour basis, without external intervention. Dosage adjustment, if necessary, is done with a special remote control, which can be used by the patients themselves. In order to substantiate the benefit of intrathecal baclofen administration, a lumbar puncture test should be performed prior to surgery. If there are no side effects such as drowsiness, dizziness, nausea, hypotension, and clinical improvement of spasticity is observed, then the patient is suitable for surgery.

 

Reducing spasticity also requires intensive physiotherapy (eg range-of-motion exercises, hydrotherapy, kinesiotherapy, etc.). By increasing functionality, patients can strengthen their muscles and have a dramatically better quality of life.

 

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Spinal cord injuries

Spondylolisthesis, Spine Fractures

Percutaneous spinal fusion, immediate mobilization, without substantial post-operative pain

With the new technique of Minimally Invasive Spinal Surgery, fractures that need surgical stabilization become simpler and less painful. With very small incisions, similar to a laparoscopic operation, the necessary stabilization materials are placed, without substantial blood loss, and the patient is discharged in 2 days. Our experience shows that patients return to their activities pretty quickly, without any pain. Even the possibility of neurological damage caused by the injury is reduced, because these surgeries last less and the muscles, bones, and ligaments are not injured, so the recovery is faster.

Patients who have suffered a fracture or traumatic spondylolisthesis, either from a car accident, falling from a height, from osteoporosis or from a tumor of the spine , are suitable to undergo these surgeries. These surgeries are performed on the cervical, thoracic, and lumbar spine.

Our results are excellent, even in the most complex and “difficult” sort of speak cases, as shown in the following images from our cases:

General information about spinal cord, bone marrow, and nerve injury

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