Restorative Surgery for Persons with Neurological Disease or Injury

SurgeryDesmond Brown, M.D.

“Diseases affecting the brain and nervous system can be devastating. Although prevention of these conditions is the ultimate goal, some of the consequences can be reduced by effective treatment and rehabilitation.”

When the brain or spinal cord is injured, the process of recovery is called neurorehabilitation. Physicians, therapists, and nurses help the patient to regain movement and function.

Orthopaedic surgery can aid the recovery from neurologic disease or injury.

Here are some of the conditions treated at the Center for Neurorehabilitation Surgery:

  • Traumatic Brain Injury
  • Stroke
  • Spinal Cord Injury
  • Cerebral Palsy
  • Multiple Sclerosis
  • Peripheral Neuropathy

Spasticity

Spasticity, manifested as excessive muscle tone and an exaggerated reflex response to movement, occurs in many conditions that affect the brain and spinal cord. Spasticity restricts the free movement of the arms and legs and can lead to contractures, a physical shortening of the muscles. Spasticity can be treated with oral medication, bracing, physical therapy, and injections of Botox (botulinum toxin A). Once a contracture becomes established it can be difficult to eliminate with these techniques, and surgery may be effective in restoring more normal range of motion and function.

Intrathecal Baclofen PumpIntrathecal Baclofen Pump

One method of treating spasticity that has been very helpful in some patients is the use of intrathecal baclofen. Baclofen (generic name lioresal) is a medication that can reduce the exaggerated muscle tone of spasticity. Although baclofen can be taken as a pill, its effects are greatly increased (and its side effects reduced) when it is given directly into the fluid surrounding the spinal cord. This can be accomplished by implanting a disc-shaped pump beneath the skin over the abdomen, with a small catheter going into the spinal fluid. The medication within the pump passes through the catheter into the spinal fluid and acts on the nerves in the spinal cord to reduce spasticity. The pump can be refilled in a physician’s office, and the dose can be adjusted with an external programming device. Intrathecal baclofen has been used in patients with cerebral palsy, traumatic brain injury, multiple sclerosis, stroke, and spinal cord injury, and may be very effective in reducing spasticity and improving comfort and function.

Contractures

One of the most harmful effects of spasticity is that it may lead to the development of contractures.  In a contracture, the muscles become physically shortened and the effective range of motion for a joint is reduced. The exact mechanism by which spasticity leads to contracture is not known. Aggressive treatment to prevent contracture is an important part of neurorehabilitation, and includes physical therapy, proper positioning, and splinting or casting. Treating spasticity with oral medication, botulinum toxim, or intrathecal baclofen may also be helpful.

Even with excellent early treatment however, contractures may develop. Contracture of the calf muscles restricts motion at the ankle, and may prevent the foot from resting flat on the ground. Contractures of the hips and knees can interfere with sitting, standing and walking. Contractures of the elbow and wrist can limit function and interfere with dressing and hygiene. Surgical lengthening of muscles and tendons may allow for better positioning and range of movemen