Longitudinal Myelotomy for Spasticity

Abstract

ARIOUS patterns of spasticity occur according to the level of total or partial lesions of the brain stem and spinal cord. 3 Stated simply, spasticity occurs because spinal reflex arcs are separated from the controlling influences that normally reach them from higher in the central nervous system. Sensory impulses may then produce either an exaggerated stretch reflex which results in spasticity or an exaggerated flexor withdrawal reflex which results in flexor spasms. Furthermore, in partial lesions a voluntary effort to move a limb may increase the activity of motor units and thus contribute to uncontrollable spasm. In some patients the considerable degree of spasticity and tendency to violent flexor spasms have a serious effect upon rehabilitation. These patients have difficulty in carrying out such procedures as transferring to and from a wheel chair or in wearing braces. They are also more liable to develop permanent deforming contractures. Excoriation and ulceration are more common, and in certain circumstances the violent muscular spasms may be painful. In certain paraplegic, quadriplegic, or paraparetic patients, this problem negates all efforts at rehabilitation. Many procedures have been tried over the years to combat this spasticity, and the multitude of procedures indicates that none are entirely satisfactory. In 1913, Foerster 4 advocated division of the posterior roots of L-2, -3, and -5, and S-1 in order to interrupt the afferent sensory component of the reflex arc. This procedure was usually followed by relief of spasticity for some time, but it eventually returned. This was presumably due to some afferent impulses still finding their way to the ante