選擇性背根切除術對於脊髓損傷併嚴重下肢痙攣之治療效果：病例報告

Spasticity refers to a velocity-dependent resistance to passive motion which was characterized as a symptom of upper motor neuron lesion. Though mild spasticity can help patients compensate for muscle weakness which is benefit for transferring and some daily living function, severe spasticity may cause difficulty in positioning, motor performance and predispose to pressure ulcer. The treatment option for spasticity includes physical therapy (positioning, stretching, range of motion exercise), splinting, oral medication (baclofen and diazepam are most commonly used), botulinum toxin or phenal block for focal spasticity, and more invasively, intrathecal baclofen pump (ITB) and selective dorsal rhizotomy (SDR). Selective dorsal rhizotomy was performed with partial resection of the dorsal roots from L2-S2 after neurophysiological interpretation and electrical stimulation. Intensive post-operation physical therapy was recommended for better therapeutic effect. The evidence of therapeutic effect on patients of spastic diplegic cerebral palsy was well documented but lacked of that for patients with spinal cord injury. This case is a 68 y/o male patient with spinal cord injury, C4 level, AIS-C. He suffered from severe spasticity complicated with bilateral lower limbs contracture. Previously he was in bed-ridden status with totally dependent daily living, besides, there was a pressure sore over sacrum. He underwent selective dorsal rhizotomy, hip adductor and hamstring release, and posterior obturator neurectomy with intensive post-operative rehabilitation. two months later, he turned out to be able to sit on a wheelchair with some ability to put on the brake, stand with support and ambulate with partial weight suspension. In addition, he could comb his hair, brush teeth, make a phone call, and feed with utensil cuff by himself. As the operative technique and intra-operative monitoring has become more and more mature, SDR may provide another safe and effective treatment option for severe spasticity of spinal cord injury.