P185. From contracture to functional movement – Minimally invasive neuro-orthopedic surgery is a feasible tool for the treatment of severe spasticity in young adults in early neurological rehabilitation

Abstract

Using photography and video we report on 3 young adults treated in our center for early neurological rehabilitation between 2011 and 2014 after acute brain injury (blood loss, anoxia, tentorial herniation). All of them developed severe painful contractures early on, were bedridden and incapable of functional movements. Systemic anti-spastic therapy and daily physiotherapy were not able to modify the degree of spasticity in a substantial manner. We applied minimally invasive tendon lengthening – i.e. myotenofasciotomy as developed by Ulzibat and colleagues for the treatment of spasticity in children – along with classical tendon lengthening techniques and extensive physiotherapy in the weeks following the procedures. In all patients we achieved normalization of leg axis, sustained verticalization including 1 patient who became able to walk again for short distances, and restoration of hand movements for assisted oral food intake. We conclude that minimally invasive tendon lengthening is a safe, effective and beneficial procedure for young adults in the setting of neurologic early rehabilitation.