Abstract
A microsurgical DREZotomy (MDT) can be useful in selected cases for the treatment of severe and diffuse spasticity in one or several limbs. This technique was introduced by Sindou in 1972 on the basis of human anatomical studies of the dorsal root entry zone. The goal of surgery is to interrupt preferentially the peripheral inputs sustaining the myotatic and polysynaptic reflexes that are exaggerated in spasticity. Nociceptive fibers in the lateral part of the DREZ are also interrupted while most of the medial tactile and kinesthetic fibers of the dorsal funiculus are partly spared. The authors treated 269 patients with severe spasticity. Spasticity in the upper limb of 94 hemiplegic patients was treated by cervical DREZotomy; spasticity in the lower limb(s) [in one (17 cases) or the two lower limbs (158 cases)] was treated by lumbosacral DREZotomy. Sacral MDT also was performed in patients with a hyperactive bladder.
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