Purpose: Multiple deformations of the lower limbs are common orthopaedic complications of central nervous system disease. Assessment is difficult. Intrathecal Lioresal® was proposed for the patients to establish the relative effects of spasticity and musculo-tendinos retraction and define a medico-surgical therapeutic strategy.
Material and methods: Between January 1999 and December 2000, 31 patients consulted for persistent knee flexion. Baclofen tests (75 - 100 µg Baclofen intrathecal) were performed in ten patients because the relative contribution of spasticity and retraction was difficult to assess. The anti-spasticity effect was observed within the first hour, with a maximal effect between the second and fourth hour. Motor function, joint motion, and function were tested during this time interval. The test was repealed approximately three days later, sometimes with higher doses depending on the level of the anti-spastic effect. Residual orthopaedic limitations were explained by musculotendinous retractions.
Results: For the ten evaluated patients, three presented musculotendinous retractions amendable by surgical treatment (tendon lengthening, proximal disinsertion), sometimes in combination with arthrolysis. For the seven patients who had hypertonic spastic contractions, medical treatment was given with, for three patients, continuous intrathecal Lioresal via pump delivery. There was a correlation between the deformation assessed after the test and the test conducted under general anaesthesia during the procedure in all patients.
Discussion: Other methods for evaluating orthopaedic deformities of the lower limbs can be used. Selective motor blocks using local anasethetics are generally reserved for patients with localised stiffness or when it may be difficult to achieve in certain patients (hip flexion). Mobilisation under general anaesthesia is another solution, but does not allow an assessment of functional gain, particularly if the goal is walking. The intrathecal Baclofen test not only allows an accurate assessment of orthopaedic retraction, but also an assessment of the functional impact of the spasticity. sometimes useful for verticalisation or walking.
Conclusion: The Baclofen intrathecal test is a simple test with a particular place in the preoperative and functional assessment of neuro-orthpaedic stiffness of the lower limbs.
P. Denormandie, E. Lo, C. Kieffer, D. Ben Smail, B. Bussel. J.B. Elis, T. Judet
Service de Chirurgie Orthopaedic, Hopital Raymond-Poincare, 104 boulevard Raymond-Poincare, 92380 Garches, France
Copyright British Editorial Society of Bone & Joint Surgery 2004
Provided by ProQuest Information and Learning Company. All rights Reserved
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