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CC BY 4.0 · Indian Journal of Neurosurgery
DOI: 10.1055/s-0045-1810050
Review Article

Surgical Approach for Spasticity: A Systematic Review

Lalit K. Banawal
1   Department of Neurosurgery, Super Speciality Hospital, Netaji Subhash Chandra Bose Medical College, School of Excellence, Jabalpur, Madhya Pradesh, India
,
Vanshika Chandrol
1   Department of Neurosurgery, Super Speciality Hospital, Netaji Subhash Chandra Bose Medical College, School of Excellence, Jabalpur, Madhya Pradesh, India
,
Shailendra Ratre
1   Department of Neurosurgery, Super Speciality Hospital, Netaji Subhash Chandra Bose Medical College, School of Excellence, Jabalpur, Madhya Pradesh, India
,
Yad Ram Yadav 
2   Department of Neurosciences, Apex Hospital and Research Center, Jabalpur, Madhya Pradesh, India
,
Jitin Bajaj 
1   Department of Neurosurgery, Super Speciality Hospital, Netaji Subhash Chandra Bose Medical College, School of Excellence, Jabalpur, Madhya Pradesh, India
› Author Affiliations
Funding This study was conducted under the research grant by Indian Council of Medical Research (grant no. IIRP-2023-2116).
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Abstract

Background

Stroke and traumatic brain injury are among the leading causes of death and disability worldwide, with spasticity being a common and debilitating complication. This condition often significantly impairs mobility and quality of life, necessitating additional treatment options such as medications and botulinum toxin injections. When spasticity becomes resistant to drug therapy, surgical interventions are considered. Several surgical treatments are available, including selective dorsal rhizotomy (SDR), dorsal root entry zone (DREZ) lesioning, C7 neurectomy, selective peripheral neurotomy (SPN), and intrathecal baclofen therapy (ITB).

Objective

This systematic review aims to analyze the mechanisms, indications, and efficacy of surgical interventions for spasticity. It will also examine the most widely accepted surgical treatments currently used to reduce spasticity and improve patient outcomes in individuals with spasticity.

Methods

A comprehensive search of PubMed, Scopus, and Google Scholar (1993–2024) was conducted, including randomized controlled trials (RCTs), case reports, case series, and systematic reviews, all following PRISMA guidelines. Eligible studies focused on surgical treatments for spasticity in the upper and lower extremities, with outcome measures such as the modified Ashworth scale (MAS) and improvements in the range of motion.

Result

The search retrieved 465 abstracts, and 42 articles were finally selected. The results of the reviewed studies suggest that surgery is a useful, safe, and enduring treatment for spastic patients. SDR benefited cerebral palsy patients with long-term motor function improvement, DREZotomy reduced spasticity and neuropathic pain, SPN showed promise in focal spasticity management, and ITB effectively managed severe spasticity.

Conclusion

Surgery provides a safe and effective solution for managing spastic patients, with durable functional improvements. It is a valuable option in spasticity treatment.

Keywords

craniocerebral trauma - denervation - functional neurosurgery - muscle spasticity - rhizotomy - stroke


Publication History

Article published online:
09 July 2025

© 2025. The Author(s). This is an open access article published by Thieme under the terms of the Creative Commons Attribution License, permitting unrestricted use, distribution, and reproduction so long as the original work is properly cited. (https://creativecommons.org/licenses/by/4.0/)

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