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Surgery is often recommended when contractures are severe enough to cause movement problems. In the operating room, surgeons can lengthen muscles and tendons that are proportionately too short. First, however, they must determine the exact muscles at fault, since lengthening the wrong muscle could make the problem worse.Finding problem muscles that need correction can be a difficult task. To walk two strides with a normal gait, it takes more than 30 major muscles working at exactly the right time and exactly the right force. A problem in any one muscle can cause abnormal gait. Furthermore, the natural adjustments the body makes to compensate for muscle problems can be misleading. A new tool that enables doctors to spot abnormal gait abnormalities, pinpoint problem muscles, and separate real problems from compensation is called gait analysis. Gait analysis combines cameras that record the patient while walking, computers that analyze each portion of the patient's gait, force plates that detect when feet touch the ground, and a special recording technique that detects muscle activity (known as electromyography). Using these data, doctors are better equipped to intervene and correct significant problems. They can also use gait analysis to check surgical results.
Because lengthening a muscle makes it weaker, surgery for contractures is usually followed by months of recovery. For this reason, doctors try to treat as many muscles at once as possible. If more than one surgical procedure is unavoidable, operations are scheduled close together.
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Selective dorsal root rhizotomy aims to reduce spasticity in the legs by reducing the amount of stimulation that reaches leg muscles via nerves. In the procedure, doctors try to locate and selectively sever over-activated nerves controlling leg muscles. Recent research suggests that this technique can reduce spasticity in some patients, particularly those who have spastic diplegia.
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In the technique of chronic cerebellar stimulation, electrodes are implanted on the surface of the cerebellum -- the part of the brain responsible for coordinating movement -- and are used to stimulate certain cerebellar nerves. While it was hoped that this technique would decrease spasticity and improve motor function, the results of this invasive procedure have been mixed.
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Stereotactic Neurosurgery is used to facilitate the management of abnormal movements, therefore dealing with the symptoms and not the disease itself. Depending on the side and part of the body that is aimed to improve, the neurosurgeon knows which spot in the brain has to be altered to achieve it; that is the target.This is a three dimensional technique for neurosurgery. It consists in taking X-rays (or other imaging) to map a structure within the Brain.. Once this is done, the coordinates are moved to a stereotactic frame, which will guide an electrode to the exact location.
Most of the time, the procedure is done under local anesthesia, depending on the conditions of the patient. The stereotactic frame is fixed in the skull and the electrode is driven through a burr hole. While small electrical discharges are applied intermittently, the surgeon watches the response of the patient and in this way, knows the exact position of the electrode within the brain. Once in the target, a larger electrical impulse is sent through the electrode to modify the brain cells at that spot.
Typically the patients are sent immediately to their room and the next day are discharged from the hospital.
For more information, see Stereotactic Neurosurgery
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Stereotaxic thalamotomy involves operating in a specific area of the brain, the thalamus, which is the brain's relay station for messages from the muscles and sensory organs. This procedure has been shown effective only for reducing hemiparetic tremors.
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Program Director, Continuum Center for Health and Healing,
Beth Israel Hospital / Albert Einstein School of Medicine
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