Surgery to reduce spasticity

Posted - November 2013 in Living with HSP - Management & Treatment News

Improved stability standing and walking

In this study, four HSPers had lower back surgery to cut selected nerve roots involved in sending impaired signals to the legs that results in spasticity. Followed up for more than 2 years, the researchers found:

significant spasticity reduction
improved standing and walking stability
improved posture and longer walking distance
no significant problems as a result of the surgery.

This type of surgery is more commonly associated with cerebral palsy. The reasons that it is not generally thought of as suitable for HSP is that HSP involves weakness as well as spasticity, and it is ‘progressive’ (gets worse over time).

Abstract

Selective dorsal rhizotomy (SDR) surgery

Pure hereditary spastic paraparesis usually presents with progressive weakness and spasticity of the legs, which is similar to spastic cerebral palsy. In this study selective dorsal rhizotomy (SDR) was performed to improve the spasticity of pure hereditary spastic paraparesis and the long-term results were followed.

A series of four patients with pure hereditary spastic paraparesis diagnosed by a multidisciplinary team received SDR. The dorsal rootlets from the L2 to S1 levels were selectively resected under electrophysiological monitoring. The patients were followed up for more than 2years to evaluate the outcome of surgery.

There was a significant reduction in muscular spasm after SDR. Standing and walking stability were improved in all patients, which led to improvement in walking posture and longer walking distance without assistance. No urinary retention, cerebrospinal fluid leak, surgical infection or kyphosis occurred.

For severe pure hereditary spastic paraparesis, SDR can reduce muscle spasm and improve standing and walking stability. These results were stable throughout follow-up. SDR performed at the level of the conus medullaris through a laminectomy from T12 to L1 or L1 to L2 requires a shorter incision, laminectomy of fewer segments, and has a shorter operation time than the usual method (laminectomy from L2 to S1). Intraoperative electrophysiological monitoring is helpful to discriminate abnormal rootlets and protect sphincter function.

SOURCE: J Clin Neurosci. 2013 Oct 20. pii: S0967-5868(13)00322-6. doi: 10.1016/j.jocn.2013.04.020. [Epub ahead of print] Copyright © 2013 Elsevier Ltd. All rights reserved. PMID: 24153323 [PubMed – as supplied by publisher]

Long-term results of selective dorsal rhizotomy for hereditary spastic paraparesis.

Kai M, Yongjie L, Ping Z.

Beijing Institute of Functional Neurosurgery, Xuanwu Hospital, Capital University of Medical Science, No. 45 Changchun Street, Xicheng District, Beijing 100053, China.

Comments on this story

Lyn posted at 3:49 pm on 7 December 2013Reply

This sounds promising … a shame it’s in china. 🙄
- Editor posted at 9:16 pm on 7 December 2013Reply
  
  Editor’s Note: This surgery is currently performed in Australia, e.g. for cerebral palsy. If this research is convincing, it could become an option for treating HSP.
Sharyn posted at 9:56 pm on 14 April 2014Reply

I would like to know what the patients’ walking ability was before surgery and how much improvement they experienced ❓ 😐
- Editor posted at 8:35 am on 15 April 2014Reply
  
  Editor’s Note: You might learn more about that by reading the full research paper. We have access to just the Abstract shown above. The full paper would describe how they measured walking ability and provide those measurements for the 4 patients pre and post-surgery. You may be able to purchase the paper online through the publisher, or another option may be to find it in a university medical school library.
sarah posted at 5:01 am on 13 June 2014Reply

I was just wondering how i could go about getting something like this done i was born with hsp and it didnt kick in till bout 6 years ago when i broke my feet it is getting worse as time goes by and the hospitals just keep on stuffing me around 🙁
Stacy posted at 5:18 am on 15 January 2017Reply

I would like to know if any further followup has been done on these patients and how they are now doing at the 5-year mark???
Neel posted at 11:04 am on 28 August 2017Reply

I also have HSP and would like to know more information on how it can be surgercally treated.
- Editor posted at 11:45 am on 28 August 2017Reply
  
  Editor’s Note:
  The researchers state at the end of their paper “Although our study provides evidence of the efficacy of SDR, it does not completely answer questions about the long-term effectiveness and risks of the treatment. More patients should be followed for a longer time. The preliminary results of our case series should encourage larger studies of SDR in HSP”.
  
  A leading Australian rehab physician, who has a lot of HSP patients, commented:
  “In Australia SDR is only used for non-progressive diseases, and only in children usually around the age of 7.”
  
  Editor: In speaking with medical professionals, they identified two problems with SDR for HSP. Firstly, benefits and advantages gained from the surgery tend to be relatively short lived (as little as two years) as HSP is a progressive condition. This is also true of tendon reassignment surgery for HSP. And secondly, reducing spasticity may amplify the impact of the muscle weakness that occurs in HSP.
  
  Perhaps printout this page from the website and take it along to a discussion with the specialist you see for your HSP.