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Ran KR, Das O, Johnston DT, Vutakuri N, Ranganathan S, Broachwala M, Chopra H, Long Azad C, Azad TD, Robinson S, Belzberg AJ, Tuffaha SH, Lubelski D. Nerve-Targeted Surgical Treatments for Spasticity: A Narrative Review. World Neurosurg 2024; 187:104-113. [PMID: 38649021 DOI: 10.1016/j.wneu.2024.04.084] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/22/2024] [Revised: 04/12/2024] [Accepted: 04/15/2024] [Indexed: 04/25/2024]
Abstract
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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Affiliation(s)
- Kathleen R Ran
- Department of Neurosurgery, Johns Hopkins Hospital, Baltimore, Maryland, USA.
| | - Oishika Das
- Department of Neurosurgery, Johns Hopkins Hospital, Baltimore, Maryland, USA
| | - David T Johnston
- McGovern Medical School, University of Texas Health Science Center at Houston, Houston, Texas, USA
| | - Neha Vutakuri
- Department of Psychology & Neuroscience, Duke University, Durham, North Carolina, USA
| | | | - Mustafa Broachwala
- Department of Physical Medicine and Rehabilitation, Johns Hopkins Hospital, Baltimore, Maryland, USA
| | - Harman Chopra
- Department of Physical Medicine and Rehabilitation, Johns Hopkins Hospital, Baltimore, Maryland, USA
| | - Chao Long Azad
- Department of Plastic and Reconstructive Surgery, Johns Hopkins Hospital, Baltimore, Maryland, USA
| | - Tej D Azad
- Department of Neurosurgery, Johns Hopkins Hospital, Baltimore, Maryland, USA
| | - Shenandoah Robinson
- Department of Neurosurgery, Johns Hopkins Hospital, Baltimore, Maryland, USA
| | - Allan J Belzberg
- Department of Neurosurgery, Johns Hopkins Hospital, Baltimore, Maryland, USA
| | - Sami H Tuffaha
- Department of Plastic and Reconstructive Surgery, Johns Hopkins Hospital, Baltimore, Maryland, USA
| | - Daniel Lubelski
- Department of Neurosurgery, Johns Hopkins Hospital, Baltimore, Maryland, USA
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Bajaj J, Verma S, Chaudhary V, Khandelwal N, Patidar J, Hedaoo K, Sinha M, Sharma M, Kukrele R, Bajaj D, Yadav N, Ratre S, Parihar VS, Yadav P, Agarwal P, Swamy MN, Yadav YR. Hyperselective Tibial Neurotomy for Relieving Spasticity and Restoring Motor Functions. Neurol India 2023; 71:1142-1145. [PMID: 38174447 DOI: 10.4103/0028-3886.391363] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/05/2024]
Affiliation(s)
- Jitin Bajaj
- Department of Neurosurgery, Superspeciality Hospital, NSCB Medical College, Jabalpur, Madhya Pradesh, India
| | - Shashikant Verma
- Department of Neurosurgery, Superspeciality Hospital, NSCB Medical College, Jabalpur, Madhya Pradesh, India
| | - Vivek Chaudhary
- Department of Neurosurgery, Superspeciality Hospital, NSCB Medical College, Jabalpur, Madhya Pradesh, India
| | - Namrata Khandelwal
- Department of Neurology, Superspeciality Hospital, NSCB Medical College, Jabalpur, Madhya Pradesh, India
| | - Jayant Patidar
- Department of Neurosurgery, Superspeciality Hospital, NSCB Medical College, Jabalpur, Madhya Pradesh, India
| | - Ketan Hedaoo
- Department of Neurosurgery, Superspeciality Hospital, NSCB Medical College, Jabalpur, Madhya Pradesh, India
| | - Mallika Sinha
- Department of Neurosurgery, Superspeciality Hospital, NSCB Medical College, Jabalpur, Madhya Pradesh, India
| | - Mukesh Sharma
- Department of Neurosurgery, Superspeciality Hospital, NSCB Medical College, Jabalpur, Madhya Pradesh, India
| | - Rajeev Kukrele
- Department of Plastic Surgery, Superspeciality Hospital, NSCB Medical College, Jabalpur, Madhya Pradesh, India
| | - Diya Bajaj
- Department of Neuropathology, Superspeciality Hospital, NSCB Medical College, Jabalpur, Madhya Pradesh, India
| | - Nishtha Yadav
- Department of Neuroradiology, Superspeciality Hospital, NSCB Medical College, Jabalpur, Madhya Pradesh, India
| | - Shailendra Ratre
- Department of Neurosurgery, Superspeciality Hospital, NSCB Medical College, Jabalpur, Madhya Pradesh, India
| | - Vijay S Parihar
- Department of Neurosurgery, Superspeciality Hospital, NSCB Medical College, Jabalpur, Madhya Pradesh, India
| | - Prashant Yadav
- Department of Plastic Surgery, Superspeciality Hospital, NSCB Medical College, Jabalpur, Madhya Pradesh, India
| | - Pawan Agarwal
- Department of Plastic Surgery, Superspeciality Hospital, NSCB Medical College, Jabalpur, Madhya Pradesh, India
| | - M N Swamy
- Department of Neurosurgery, Superspeciality Hospital, NSCB Medical College, Jabalpur, Madhya Pradesh, India
| | - Y R Yadav
- Department of Neurosciences, Apex Hospital and Research Center, Jabalpur, Madhya Pradesh, India
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