Dorsal Longitudinal T-Myelotomy (Bischof II Technique): A Useful Antiquated Procedure for Treatment of Intractable Spastic Paraplegia.

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Dorsal Longitudinal T-Myelotomy (Bischof II Technique): A Useful Antiquated Procedure for Treatment of Intractable Spastic Paraplegia.

World Neurosurg. 2018 May 10;:

Authors: Sitthinamsuwan B, Khampalikit I, Phonwijit L, Nitising A, Nunta-Aree S, Suksompong S

Abstract
OBJECTIVE: Dorsal longitudinal T-myelotomy is a long-established operation to treat severe spastic paraplegia. The present study aimed to report this surgical technique and investigate the efficacy of T-myelotomy for spasticity relief.
METHODS: All cases undergoing T-myelotomy for treatment of intractable spastic paraplegia during 2009-2017 were included. The spasticity severity was evaluated using the Modified Ashworth Scale (MAS), Penn Spasm Frequency Scale (PSFS), Adductor Tone Rating Scale (ATRS), degree of passive range of motion (PROM), and occurrence of abdominal muscle spasms. Other clinical assessments included deep tendon reflex assessed by the National Institute of Neurological Disorders and Stroke (NINDS) scale, Babinski sign, healing of decubitus ulcers, and ambulatory status.
RESULTS: Fourteen patients with a mean age of 39.3±13.4 years were included. The 7 patients with abdominal muscle spasms before surgery had no spasms after surgery. The Babinski sign was absent in all cases after surgery. Unhealed pressure ulcers in all nine cases were healed after surgery. All four patients with a preoperative bed-bound condition were able to ambulate with a wheelchair. A statistically significant improvement in mean MAS score, degree of PROM, and NINDS scale score was found in the subgroup and overall analyses. There was also a statistically significant improvement in the PSFS and ATRS scores.
CONCLUSIONS: Dorsal longitudinal T-myelotomy remains an effective option for the treatment of intractable spastic paraplegia. It is suitable for, and may be an alternative to intrathecal baclofen therapy for, patients with complete spinal cord lesion or patients without hope of regaining motor function.

PMID: 29753900 [PubMed - as supplied by publisher]

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