Subarachnoid Alcohol Block in Paraplegia

Abstract

I NVOLUNTARY reflex spasm of the paralyzed muscles is present to some degree with most patients following permanent injury to the spinal cord. The etiology of these powerful muscular contractures remains a mystery. Likewise, the absence of this mass reflex in some patients is equally difficult to explain. Immediately after injury a period of so-called spinal shock exists, during which the paralysis is of a flaccid character. Some weeks later reflex activity reappears and may progress to marked hyperactivity and involuntary muscttlar spasms. At times the reflex spasm, evoked by simply touching the skin over the paralyzed area, may be so powerful that it is physically impossible for the examiner to overcome the strength of the muscular contractions. Why are these mass reflexes so important in the management of the paraplegic patient as to justify the injection of absolute alcohol in large amounts into the subarachnoid space? Every paraplegic patient's greatest desire is to walk, even though it may be only with the aid of braces and crutches. The mass reflexes serve as a formidable obstacle to this achievement. The patient cannot maintain an erect position even if he is physically able to handle crutches with his arms and shoulders. Flexion deformities are frequent, often with secondary structural contractures. These add to the patient's discomfort and increase the danger of trophic ulcers. Control of ulcerated areas, much less repair, is impossible if the deformities persist. Reflex spasm frequently involves the pelvis and abdomen. The urinary problem is increased because of reflex bladder spasm. If a urinal is used, violent spasms may result in more frequent wetting of the bed, thus adding to the patient's discomforts and the nursing problems. Abdominal spasms are a source of great annoyance to the patient, at times painful, and greatly interfering with his rest and sleep. Anterior rhizotomy has been used to relieve mass flexion reflexes with excellent results in selected cases. 11 The procedure consists in section of the anterior spinal nerve roots from the 10th thoracic through and including the 1st sacral nerve root bilaterally. Thus, the spastic paralysis of a spinal cord lesion is converted into the flaccid paralysis of a lower motor neuron lesion. Technically, this procedure is successful in overcoming the disabling