Selective posterior rhizotomy for painful spasticity in the lower limbs of hemiplegic patients after stroke: report of two cases.

Abstract

Selective posterior rhizotomy (SPR) has been performed mainly in children with cerebral palsy. Seldom has the use of SPR been reported for reduction of spasticity after stroke. We describe two elderly patients with hemiplegia who underwent unilateral SPR for pain caused by spasticity after stroke. The first patient was a 68-year-old woman who experienced spasticity and pain in her right leg during the chronic stage of a left cerebral infarction. The second patient was an 89-year-old man who had intolerable spastic pain in his left hemiplegic leg 3 months after a right cerebral infarction. Both patients underwent unilateral SPR on the spastic side to reduce the pain. After surgery, the patients' pain resolved. In the first patient, the ability to perform activities of daily living also improved. Antispastic medications are often sufficient for treatment of post-stroke spasticity. In selected cases, however, SPR can be beneficial for improving painful spasticity.