The authors report their experience using dorsal longitudinal myelotomy in treating spasticity in 20 patients with complete
spinal cord injuries. These patients suffered from severe painful flexor/extensor
spasms that prevented them from wheelchair ambulation and/or their
decubitus ulcers healing. All were receiving large doses of various oral drugs, including
baclofen, which had failed to control their spasticity, and all underwent a modification of a posterior T-myelotomy as first described by Bischof. All 20 patients enjoyed immediate complete relief of their painful
spasms, although two (10%) eventually experienced return of their
spasms and are thus classified as long-term failures. Seventeen patients succeeded in markedly reducing, or being completely weaned from, their
antispasmodic medications. In 11 of 14 patients, nonhealing
decubitus ulcers subsequently healed with treatment. Bladder function was unchanged from the preoperative status in all patients. Chronic intrathecal
baclofen infusion has recently been reported as an effective treatment of the spasticity of
paraplegia. The results of this study, along with previous reports advocating dorsal longitudinal myelotomy, suggest that this approach is an efficacious alternative to chronic
baclofen infusion in reducing spasticity for complete paraplegics. Considering the cost of the
infusion pump, along with the fact that chronic intrathecal
baclofen therapy necessitates long-term medical supervision, it appears that myelotomy is superior for this select group of patients who have no hope of regaining voluntary motor function.