The Algorithm of Providing Surgical Care to the Patients with Local Spasticity in the Lower Extremities with Organic Lesions of the Central Nervous System
The present article describes an algorithmic approach to the treatment of local spasticity of the lower limbs in patients with organic lesions of the central nervous system (CNS). The number of patients with organic CNS lesions increased, the reason is rapid technological progress and urbanization.
The question of improving the quality of life of patients with organic lesions of the CNS in the late period in terms of urgency comes to the fore in neurology and neurosurgery. One of the main causes for the low quality of life of these patients is abnormal muscle spasticity. Spasticity is defined as a motor disorder that is a part of a syndrome of corticospinal tract defeat, is characterized by speed-dependent increase in muscle tone, and is associated with increased tendon reflexes due to hyperexcitability of stretch receptors.
Similar patients with difficulties can move, their care becomes more complicated. Spasticity in the adductor muscles of the hip complicates nursing, making it impossible to form the hip joints in patients with cerebral palsy. Local spasticity in the flexors of the foot and toes limit the functionality of patients, makes it impossible to develop skills of standing and walking, leads to the abnormal posture, spinal curvature, muscle-tendon and joint contractures.
During a thorough preoperative selection, there has been conducted a test with paraneural blockade of nerves using bupivacaine that innervate the spastic muscle. In the absence of irreversible fibrodegenerative changes in the muscles and maintaining mobility in joints during anesthetic action, there occurred a significant improvement of the patient’s state, accompanied by a significant decrease in spasticity and increased range of motion in joints.
All patients in the early postoperative period revealed a decrease in the muscle tone and a significant increase in range of motion in joints. Due to this, spastic syndromes disappeared that made it possible to carry out early rehabilitation, to begin the formation of statomotor skills already at this stage.
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