Nerve-targeted Surgical Treatments for Spasticity: A Narrative Review

Research Lead-in

Kathleen R Ran, Oishika Das, David T Johnston, Neha Vutakuri, Sruthi Ranganathan, Mustafa Broachwala, Harman Chopra, Chao Long Azad, Tej D Azad, Shenandoah Robinson, Allan J Belzberg, Sami H Tuffaha, Daniel Lubelski



Spasticity is a potentially debilitating symptom of various acquired and congenital neurologic pathologies that, without adequate treatment, may lead to long-term disability, compromise functional independence, and negatively impact mental health. Several conservative as well as non-nerve targeted surgical strategies have been developed for the treatment of spasticity, but these may be associated with significant drawbacks, such as adverse side effects to medication, device dependence on intrathecal baclofen pumps, and inadequate relief with tendon-based procedures. In these circumstances, patients may benefit from nerve-targeted surgical interventions such as (i) selective dorsal rhizotomy, (ii) hyperselective neurectomy, and (iii) nerve transfer. When selecting the appropriate surgical approach, preoperative patient characteristics, as well as the risks and benefits of nerve-targeted surgical intervention, must be carefully evaluated. Here, we review the current evidence on the efficacy of these nerve-targeted surgical approaches for treating spasticity across various congenital and acquired neurologic pathologies.

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“The AANS/CNS Spine Section brings together neurosurgeons, orthopedic spine surgeons, spine surgery fellows, as well as residents and advanced practice providers focused on spinal surgery. The Spine Section advances our interests, represents us in national advocacy, and disseminates science. Becoming a member means joining this exceptional community and helping it grow.” ...Read More >