Percutaneus radiofrequency rhizotomy for the managment of severe spastic paraplegia in adults.

Abstract

Introduction: Severe spastic paraplegia is a comoon condition in spinal cord injury, when medical treatment fails, the most common surgical treatment is intrathecal baclofen therapy and selective dorsal rhizotomy. We propose the lesion of the root at the foraminal level by radiofrequency percutaneous rhizotomy (RF-DRG) as a minimally invasive, useful and low-cost option.
Materials and methods: The surgical technique is described in one case where foraminal RF-DRG was performed in a patien with severe flexor/adductor hip stasticity associated with severe spasms and pain that limits personal care. The patient was evaluated by a multidisciplinary team throughout its evolution using the scales of Spasm Frequency Scale (SFS), Medical Research Council Scale (MRC), Modified Asworth Scale (MAS), Adductor Tone Rating (ATRS) and Global Pain Scale (GPS).
Results: The procedure was performed once, and we found a 50% improvement in SFS, MAS, ATRS and GPS. This has enabled him to improve his quality of life with respect to personal and sexual care. The patient had a follow-up at 5 years and didn´t need to repeat RF-DRG.
Discussion: RF-DRG is proposed for severe paraplegic patients (MRC 0), with spasms, clonus and severe uncontrollable and intractable spasticity. RF-DRG is a minimally invasive and reproducible technique.
Conclusion: RF-DRG is an option for sequential paraplegic patients with severe spasticity. Its effectiveness over time should be defined with long-term controlled studies.