History and evolution of surgical treatment for spasticity: a journey from neurotomy to selective dorsal rhizotomy.

The evolution of neurosurgical approaches to spasticity spans centuries, marked by key milestones and innovative practitioners. Probable ancient descriptions of spasmodic conditions were first classified as spasticity in the 19th century through the interventions of Dr. William John Little on patients with cerebral palsy. The late 19th century witnessed pioneering efforts by surgeons such as Dr. Charles Loomis Dana, who explored neurotomies, and Dr. Charles Sherrington, who proposed dorsal rhizotomy to address spasticity. Dorsal rhizotomy rose to prominence under the expertise of Dr. Otfrid Foerster but saw a decline in the 1920s due to emerging alternative procedures and associated complications. The mid-20th century saw a shift toward myelotomy but the revival of dorsal rhizotomy under Dr. Claude Gros' selective approach and Dr. Marc Sindou's dorsal root entry zone (DREZ) lesioning. In the late 1970s, Dr. Victor Fasano introduced functional dorsal rhizotomy, incorporating electrophysiological evaluations. Dr. Warwick Peacock and Dr. Leila Arens further modified selective dorsal rhizotomy, focusing on approaches at the cauda equina level. Later, baclofen delivered intrathecally via an implanted programmable pump emerged as a promising alternative around the late 1980s, pioneered by Richard Penn and Jeffrey Kroin and then led by A. Leland Albright. Moreover, intraventricular baclofen has also been tried in this matter. The evolution of these neurosurgical interventions highlights the dynamic nature of medical progress, with each era building upon and refining the work of significant individuals, ultimately contributing to successful outcomes in the management of spasticity.

[History of neurosurgical treatment of spasticity]. / Historique du traitement neurochirurgical de la spasticité.

The history of neurosurgery for spasticity is strongly linked to the beginning of neurosurgery. With the discovery of the stretch reflex by Sherrington and the quality of the clinical studies at that time, especially the description of the different kinds of hypertonia by Babinski, the new surgeons of the nervous system started early with interruption procedures on dorsal roots (Foerster) or peripheral nerves (Lorenz, Stoffel). In France, this field of functional neurosurgery grew rapidly. Gros in Montpellier improved the technique of dorsal rhizotomy, while Sindou in Lyons, created the technique of drezotomy after studies on pain mechanisms. The history was then followed in Chicago by Penn and Kroin who developed the technique of intrathecal baclofen which indications are still increasing today. Improvement of knowledge on neurophysiology and control of movement lead to an optimisation of the surgical procedures where French speaking neurosurgery plays an important role.