What is Spasticity?
Spasticity, or spasms, are spontaneous, involuntary, uncoordinated reflex movements of muscles, which can occur following spinal cord injury. While some spasticity may be useful, spasms can become a problem and interfere with wheelchair positioning, transfers, and sleeping. When spasticity becomes a problem and cannot be treated adequately with medical management, surgical intervention may be appropriate.
These surgical options are only used when spasticity cannot be treated with medication. Sometimes, a spinal cord untethering or cyst shunt surgery is an appropriate option for spasticity when medication does no work. For more information about this option, see Posttraumatic Tethered Cord and Syringomyelia.
- Intrathecal Baclofen Pump: This is a surgical procedure involving the placement of a pump, which delivers spasticity medication through a catheter into the spinal fluid space around the spinal cord. This procedure is not destructive to the spinal cord and spasticity control can be adjusted by programming the dosing of spasticity medication delivered through the pump.
- Selective Sensory Microrootlet Section (SSMS): This is a surgical procedure which involves cutting selected sensory nerve rootlets entering the spinal cord. Bone is removed from the back of the spine, called laminectomies, which allows us to get the spinal cord. The covering around the spinal cord (dura) is opened and the selected sensory nerve rootles are identified and cut. This is a destructive procedure to the nerve rootlets coming off of the spinal cord and is not reversible. Patients who have preserved sensory function below the level of injury are not candidates for this surgery.
- Dorsal Root Entry Zone Microcoagulation: This is a surgical procedure which involves heating targeted regions of the spinal cord that are contributing to spasticity. This procedure also requires laminectomies and opening the dura to get to the spinal cord. This is a destructive procedure to the spinal cord and is not reversible. Patients who have preserved sensory or motor function below the level of injury are not candidates for this surgery.