Spasticity Table 10 Neurosurgical Interventions for Reducing Spasticity

Author Year
Country
Score
Research Design
Total Sample Size

Methods

Outcome

Livshits et al. 2002
Israel
PEDro=5
RCT
NInitial=40,
NFinal=32

Population: Pourpre group: Mean age: 27.6 yr; Gender: males=15, females=5; Level of injury: paraplegia=20; Level of severity: complete, incomplete; Mean time with spasticity: 2.8yr; Bischof II group: Mean age: 27.1 yr; Gender: males=14, females=6; Level of injury: paraplegia=20; Level of severity: complete, incomplete; Mean time with spasticity: 2.8 yr.
Intervention: Longitudinal T-myelotomy by Pourpre versus Bischof II technique.
Outcome Measures: Short form of McGill pain questionnaire (SFM), Present Pain Intensity (PPI), Visual analog score for pain (VAS), Ashworth scale (AS), Penn Spasm Frequency (PSF) scale. All collected prior to surgery and 6 mo, 5 yr and 10 yr post-surgery.
  1. Authors states that “good” versus “bad” results with respect to spasticity were obtained with the Pourpre technique in 90% of subjects at 6 mo, 75% at 5 yr and 64.7% at 10 yr. The Bischof II technique was less effective in that “good” effects were seen in 65% of subjects at 6 mo, 45% at 5 yr and 40% at 10 yr. The author did not specify what constituted a “good” versus a “bad” effect other than to say it was a return of spasticity.
  2. AS scores and PSF scale scores were significantly reduced relative to pre-surgery values (p values unreported).
  3. People undergoing the Pourpre technique had significantly reduced AS scores and PSF scores than those undergoing the Bischof II technique (p values unreported).
  4. Pain measures were relieved in all cases although there were successively increasing SFM, PPI and VAS scores at 6 mo versus 5 yr versus 10 yr (p<0.0001 for all).
  5. Pain was relieved better (i.e., lower scores for all measures at all follow-up times) for the Pourpre technique versus Bischof II technique.

Ewelt et al. 2010
Switzerland
Case Series
N=15

Population: Mean age: 50.4 yr; Gender: males=13, females=2; Injury etiology: traumatic syringomyelia and tethered cord=13, spinal ependymoma and surgical cord injury =2; Level of injury: paraplegia, T3-T9.
Intervention: Laminectomy, adhesiolysis, cordectomy.
Outcome Measures: 3-point scale for spasticity.
  1. 2 patients improved in their spasticity.
  2. 9 patients stabilized in spasticity symptoms.
  3. 4 patients reported further spastic deterioration of their lower limbs.

Falci et al. 2009
USA
Case Series
N=362

Population: Mean age: 40.5 yr; Level of injury: C6=163, C6-T1=83, T1=116; Injury severity: AIS A=231, AIS B=36, AIS C=42, AIS D=51, AIS E=2.
Intervention: Surgery to arrest progressive myelopathy.
Outcome Measures: Self-reported change in spasticity.
  1. 59% reported improvement of spasticity.
  2. 27% reported no change in spasticity.
  3. 13% reported worsening of spasticity.

Putty & Shapiro 1991
USA
Case series
NInitial=23,
NFinal=20

Population: Injury etiology: SCI=11, MS=7, other=2; Age range: 22-69 yr; Gender: males=12 females=8; Level of injury: C5-T9; Level of severity: complete, incomplete; Time since injury range: 2–23 yr.
Intervention: Posterior T-myelotomy.
Outcome Measures: Subjective clinical impression.
  1. No statistical results were reported; 9 of 10 patients with SCI had relief from spasms (1 died, unrelated to surgery).

Note: AIS = ASIA impairment scale

top