Together with Dr. Giulio Gasperini, Director of the Spasticity and Movement Disorders Unit, we discuss an innovative minimally invasive procedure for the treatment of spasticity
The approach, born from an insight by Dr. Franco Molteni, Scientific Director of VBRRII, applies laser technology to the management of spasticity through a percutaneous technique, expanding current interventional options in neurorehabilitation. In five key points, we explain how this technique works and how it is integrated into the clinical decision-making process.
1) Based on the clinical experience, laser can be used for different indications depending on the patient’s condition: a) selective neurotomies of the motor branches directed to the target muscle to treat spasticity patterns, b) myotendinous junction lengthening to treat muscle contractures, and c) a combination of both to treat the typical mixed picture of spastic myopathy and neurological disorder, thereby expanding therapeutic possibilities within the same procedural setting.
2) The procedure is performed under local anesthesia and is extremely brief, generally lasting few minutes per target. The laser system also enables simultaneous coagulation, reducing the risk of hematoma and making the intervention particularly suitable for fragile patients or those with significant comorbidities.
3) Intraoperative monitoring of the clinical effect is possible, allowing real-time assessment of functional response and modulation of the extent of the procedure. This enables highly precise personalization of the treatment and direct control over the “dosage” of the intervention.
4) Indication for treatment is based on an extremely accurate functional evaluation, integrating clinical examination, dynamic electromyography, kinematic movement analysis, and selective diagnostic nerve blocks with local anesthetic. Only through this comprehensive assessment is it possible to precisely identify the structure responsible for the functional impairment and define an appropriate goal.
5) This minimally invasive surgery does not replace major neuro-orthopedic surgery when indicated — for example, in cases of significant structural contractures, muscle imbalances requiring tendon transfers, or bone involvement — but represents a highly selective intermediate option, significantly expanding the therapeutic armamentarium in the management of spasticity.
To date, several patients have been treated, with clinically relevant and encouraging outcomes.
