Rizotomía dorsal selectiva como opción terapéutica en la espasticidad. Indicaciones y resultados

Abstract

Spasticity, which is a very frequent sequela of neurological diseases, is useful for compensating for loss of strength and enabling the patient to stand, if it is not excessive. Otherwise, it is contraindicative and requires specific treatment.Spasticity is a spinal cord dysfunction triggered by the lack of upper motoneuron inhibiting afferents and, hence, its treatment can be centred either on a level above that of the lesion itself, if the descending pathways remain functional, or on the lesion, that is, on the spinal cord, by means of neurostimulation, intrathecal drugs or ablative procedures. Ablative procedures, which are essentially oriented towards reducing the afferents in order to diminish medullar reflex hyperexcitability, are indicated in children with spastic cerebral palsy. Thanks to a rigorous detailed study that is conducted beforehand, selective dorsal rhizotomy (SDR) allows us to determine which groups of muscles must be treated. Based on intraoperative neurophysiological studies and monitoring and the use of microsurgical techniques, the dorsal rhizome turns out to be very selective after the perfect identification of the rootlets that are to be preserved. Following the qualitative and quantitative valuation of diverse parameters, post operative results show significant improvements in the functional performance of the child at one year after the intervention, and these are maintained and increase in the next few years. A strict programme of physiotherapy and rehabilitation is very effective and enables patients to enjoy greater autonomy.The use of SDR enables us to remove excessive spasticity, correct anomalous postures and reduce collateral pain. Its successful performance is depends on the work of a multidisciplinary team and on the overall approach to the disease in each case.