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THE MANAGEMENT OF SPASTICITY IN THE SPINAL INJURED PATIENT
Author(s) -
Acland R. H.
Publication year - 2007
Publication title -
anz journal of surgery
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 0.426
H-Index - 70
eISSN - 1445-2197
pISSN - 1445-1433
DOI - 10.1111/j.1445-2197.2007.04124_12.x
Subject(s) - spasticity , medicine , baclofen , spinal cord injury , muscle contracture , conus medullaris , rehabilitation , physical medicine and rehabilitation , intensive care medicine , physical therapy , spinal cord , surgery , agonist , receptor , psychiatry
Spasticity is one of the hallmarks of the upper motor neurone syndrome which occurs following injury to the spinal cord anywhere above the level of the conus medullaris (approx L1). Early effective management of spasticity can prevent a multitude of complications. Persistent spasticity can result in contractures which significantly impair functional independence. There is a long history of the use of various surgical interventions for this complication. Physical therapy is pivotal in the overall management. A variety of pharmacological approaches are commonly used, however efficacy has to be balanced against adverse effects. The botulinum industry has limited benefit but can be useful in focal spasticity. In this presentation I will discuss the use of baclofen delivered via intrathecal catheters connected to sophisticated implanted pumps. In Christchurch we have had a multidisciplinary team providing this service for New Zealand. I will provide the results of our eight years experience in the use of intrathecal baclofen therapy (ITB). Assessment, baclofen pharmacology, surgical technique, efficacy, complications and costs will be discussed. The future challenges will also be highlighted.