E-Poster P 117 Does Spinal Cord Decompression Reduces Spasticity in Patients with Spinal Cord Injury and Residual Compression?

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1 E-Poster P 117 Does Spinal Cord Decompression Reduces Spasticity in Patients with Spinal Cord Injury and Residual Compression? R Yurac, S Ramírez, S Mandiola, M Lecaros, JJ Zamorano, C Tapia, F Ilabaca, A Urzúa, J Fleiderman. Spine Surgery Unit, Hospital del Trabajador-Asociación Chilena de Seguridad, Santiago, Chile EURO SPINE 2013 Liverpool, United kingdom, October 3-4, 2013

2 Introduction Spasticity is a sensory motor control disorder, resulting from a superior motoneuron injury and it presents as involuntary muscle activation, both intermittent and sustained There is an increased muscular tone due to the hyperexcitability of the stretching reflex It is present in up to 70% of the patients with spinal cord injuries (SCI) Other signs of spasticy: - Paresis - Clonus - Hyperrreflexia - Babisnki sign - Flexor reflexes - Flexor spasms Lance, Neurology 1980 Putty, Neurosurg 1991 Noreau, Am J Phys Med Rahabil 2000 Stevenson, Clin Rehabil 2010

3 Introduction Stepwise treatment for spasticity Nonpharmacological -Treatment of intercurrent pathologies -Physiotherapy Pharmacological -Baclofen -Diazepam -Clonidine -Tizanidine -Pregabalin Neurosurgical Spasticity resistant to pharmacological treatment -Rhizotomies -Myelotomy -Spinal cord decompression

4 Introduction We have observed that some SCI patients evolve with residual spinal cord compression, usually associated to progressive spasticity, resistant to pharmacological treatment These patients were treated with surgical decompression of the spinal cord in order to reduce spasticity, assuming that the compression was a key factor in spinal cord stimulation There is no literature available regarding the results of this procedure in this type of patients

5 Objective Describe the clinical results of surgical decompression of the spinal cord for the treatment of refractory spasticity in patients with a previous traumatic SCI and residual spinal cord compression, as measured by the pre and post op modified Ashworth scale for spasticity and drug requirements

6 Materials & Methods Type of Study: Case series Review of the medical records database of patients with traumatic SCI treated in our institution between 1992 and 2009 (196 patients) We identified three patients who evolved with spasticity, which was resistant to pharmacological treatment Patients were studied with CT and MRI, revealing focal spinal cord compression due to bone spurs Surgical decompression through a posterior approach was performed in all three patients The intervention s effect was assessed through: Baseline and post surgery modified Ashworth scale: Baseline and post surgery drug requirements

7 Results Demographics & Type of Injury Follow-Up Until Surgery Pre op Spasticity (Ashworth*) Post op Spasticity (Ashworth*) Post op Drug Requirements 36 year-old male B1 AO T11-T12 ASIA A 35 year-old male C1 AO T5-T7 ASIA A 48 year-old male B1 AO T1-T4 ASIA A 1 year 3 1 No drugs required 8 years 3 1 Baclofen unchanged, pregabalin and diazepam suspended 2 years 3 2 Baclofen unchanged, pregabalin suspended * Ashworth modified scale: progressive spasticity severity from Grades 0 to 4

8 Conclusions In our experience, spinal cord decompression surgery presents good results in patients with a previous traumatic SCI and refractory spasticity in the context of residual cord compression due to bone spurs This procedure should be considered as a less aggressive alternative to the spinal cord surgeries that are usually indicated in these patients

9 Excellence in Spine

10 Disclosure The authors have no financial relationships to disclose