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).
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.