Spasticity

Orthopedic Surgery for Spasticity

Orthopedic surgery is the most frequently used surgical procedure for spasticity. The targets of these surgeries are the muscle, tendon, or bone in a spastic limb. The goals of surgery may include reducing spasticity, increasing range of motion, improving access for hygiene, improving tolerability of braces, or reducing pain.

The most common orthopedic procedure is a contracture release. In this procedure, the tendon of a contractured muscle is cut either partially or clean through. The joint is then positioned at a more normal angle, and a cast is applied. Regrowth of the tendon to this new length occurs over several weeks. Serial casting may be used to gradually extend the joint. Following cast removal, physical therapy is used to strengthen the muscles and improve range of motion. The most common site for contracture release is the Achilles tendon. The tendon is lengthened to correct "equinus" deformity, in which contracture of the calf muscles pull the foot downward to point the toes. Other common targets are contractures involving muscles of the knees, hips, shoulders, elbows, and wrists.

A tendon transfer moves the attachment point of a spastic muscle. When the tendon is transferred to a different site, the muscle can no longer pull the joint into a deformed position. In some situations, the transfer allows improved function. In others, the joint retains passive but not active function. Ankle balancing procedures are among the most effective interventions.

Osteotomy can be used to correct a deformity that does respond to other corrective procedures. In an osteotomy, a small wedge is removed from a bone to allow it to be repositioned or reshaped. A cast is applied while the bone heals in a more natural position. Osteotomy procedures are most commonly used to correct hip displacements and foot deformities.

Arthrodesis is a fusing together of bones that normally move independently. This fusion limits the ability of a spastic muscle to pull the joint into an abnormal position. Arthrodesis are most commonly performed on the bones in the ankle and foot.

Osteotomy and arthrodesis are usually accompanied by contracture release surgery for fuller correction of the joint deformity.