Selective cervical dorsal rhizotomy to relieve upper-limb spasticity after stroke or spinal cord injury - Report of five cases

Yu Long Hsin, Tomor Harnod, Terry B.J. Kuo, Chain Fa Su, Shinn Zong Lin

Research output: Contribution to journalArticle

2 Citations (Scopus)

Abstract

Objective: Myelopathy is the most serious sequela after central nervous system insult. Due to loss of inhibition from upper neurons, hyperreflexia, spasticity, cramping pain, and paresthesia are typically noted with numbness over the limbs. Severity of spasticity is measured with the modified Ashworth scale (MAS). For patients with low-grade spasticity (MAS 1, 1+, and 2), oral medication, physical therapy, and occupational therapy can provide satisfactory results. However, for patients with high-grade spasticity (MAS 3 and 4), adjuvant therapies, such as selective dorsal rhizotomy, are needed. Materials and Methods: Since 2001, we have used selective cervical dorsal rhizotomy in Taiwan for eight spastic upper limbs in five patients. A posterior approach to the spinal canal is made under general anesthesia. After opening the dura, the selected roots are identified with anatomic landmarks and confirmed with intraoperative nerve-root stimulation. Two dorsal roots (C-5, C-6) are selected for spasticity of the upper arm, whereas C-7, C-8, and T-1 are selected for spasticity of the forearm and hand. A 50% to 80% mechanical section is performed one by one for each root. Results: At the 3 month follow-up, reduction of mean MAS grade from 3.5 to 1+ was demonstrated (p = 0.008). Spasticity of both elbow and wrist joints was reduced by C-7, C-8 and T-1 dorsal rhizotomy. Conclusions: In our experience with a limited number of patients, selective cervical dorsal rhizotomy relieves upper-limb spasticity after central nervous system insults such as stroke or spinal cord injury.

Original languageEnglish
Pages (from-to)371-375
Number of pages5
JournalTzu Chi Medical Journal
Volume16
Issue number6
Publication statusPublished - Dec 2004
Externally publishedYes

Fingerprint

Rhizotomy
Spinal Cord Injuries
Upper Extremity
Stroke
Central Nervous System
Anatomic Landmarks
Wrist Joint
Elbow Joint
Abnormal Reflexes
Spinal Canal
Muscle Spasticity
Hypesthesia
Paresthesia
Spinal Nerve Roots
Spinal Cord Diseases
Occupational Therapy
Taiwan
Forearm
General Anesthesia
Arm

Keywords

  • Dorsal root section
  • Rhizotomy
  • Spasticity
  • Spinal cord injury
  • Stroke

ASJC Scopus subject areas

  • Medicine(all)

Cite this

Selective cervical dorsal rhizotomy to relieve upper-limb spasticity after stroke or spinal cord injury - Report of five cases. / Hsin, Yu Long; Harnod, Tomor; Kuo, Terry B.J.; Su, Chain Fa; Lin, Shinn Zong.

In: Tzu Chi Medical Journal, Vol. 16, No. 6, 12.2004, p. 371-375.

Research output: Contribution to journalArticle

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AU - Lin, Shinn Zong

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N2 - Objective: Myelopathy is the most serious sequela after central nervous system insult. Due to loss of inhibition from upper neurons, hyperreflexia, spasticity, cramping pain, and paresthesia are typically noted with numbness over the limbs. Severity of spasticity is measured with the modified Ashworth scale (MAS). For patients with low-grade spasticity (MAS 1, 1+, and 2), oral medication, physical therapy, and occupational therapy can provide satisfactory results. However, for patients with high-grade spasticity (MAS 3 and 4), adjuvant therapies, such as selective dorsal rhizotomy, are needed. Materials and Methods: Since 2001, we have used selective cervical dorsal rhizotomy in Taiwan for eight spastic upper limbs in five patients. A posterior approach to the spinal canal is made under general anesthesia. After opening the dura, the selected roots are identified with anatomic landmarks and confirmed with intraoperative nerve-root stimulation. Two dorsal roots (C-5, C-6) are selected for spasticity of the upper arm, whereas C-7, C-8, and T-1 are selected for spasticity of the forearm and hand. A 50% to 80% mechanical section is performed one by one for each root. Results: At the 3 month follow-up, reduction of mean MAS grade from 3.5 to 1+ was demonstrated (p = 0.008). Spasticity of both elbow and wrist joints was reduced by C-7, C-8 and T-1 dorsal rhizotomy. Conclusions: In our experience with a limited number of patients, selective cervical dorsal rhizotomy relieves upper-limb spasticity after central nervous system insults such as stroke or spinal cord injury.

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