Surgical treatment for spasticity is a controversial matter, with options ranging from those who suggest a staunchly conservative approach, leaving surgery only to catastrophic cases with structural deformities, to those who indicate early surgery when neurological stabilisation has still not been attained.
There are several variables to consider when prescribing treatment: age, severity, stabilisation of neurological injury, degree of deformity, voluntary neuromuscular control and cognitive capacity.
We consider the following for the indication for surgical treatment:
- When is surgery indicated?
- What are our objectives?
- How will we achieve them?
This decision must be taken by the various members of the healthcare team, and we will suggest it:
- When the neurological injury has stabilised, provided this is possible.
- When rehabilitation resources have been exhausted (physical therapy, orthopaedic devices, medication, botulinum toxin, placement of baclofen pump).
- When it interferes with activities of daily living, the deformities impede function, make hygiene difficult or have a serious aesthetic impact.
OBJETIVE: Recover or acquire the highest possible functional level and independence, and correct deformities.
- Potentially functional patient: unaided walking as far as possible, and the hand's ability to grip.
- Patient without functional capacity: facilitate care, personal hygiene and image.
- Medical – rehabilitation: physiotherapy, orthopaedic devices, medication, botulinum toxin.