Surgical treatment of chronic pain syndromes and spasticity is used when conservative methods fail to provide sufficient relief. The primary goal of these procedures is to reduce pain intensity or eliminate excessive muscle tone that restricts movement and significantly decreases the patient’s quality of life.
Indications for surgical treatment
Chronic pain syndromes:
- Trigeminal neuralgia.
- Post-traumatic or post-operative pain.
- Radiculopathy.
- Cancer-related pain resistant to therapy.
Spasticity:
- Post-stroke spasticity.
- Spasticity associated with cerebral palsy (CP).
- Spastic conditions in multiple sclerosis and spinal cord injuries.
Resistance to medical therapy — lack of sufficient effect from medications, physiotherapy, and nerve blocks.
Reduced quality of life — limited mobility, severe pain, impaired self-care.
Methods of surgical treatment for spasticity and chronic pain
Neurostimulation. The principle of the method is implantation of a device that generates electrical impulses to suppress pain signals or abnormal muscle activity.
Spinal cord stimulation (SCS): electrodes are placed in the epidural space. Indications include chronic back pain, radiculopathy, and ischemic pain.
Deep brain stimulation (DBS): electrodes are implanted into deep brain structures. Indications include neuropathic pain and post-stroke spasticity.
Peripheral nerve stimulation: electrodes are placed around the affected nerve. Indications include localized pain syndromes (neuralgias). Advantages include minimal invasiveness and reversibility (the device can be turned off or removed).
Destructive procedures. The principle of these methods is targeted destruction of neural structures responsible for transmitting pain or spastic impulses.
Main types:
Rhizotomy: sectioning of the dorsal spinal nerve roots that transmit pain signals.
Indications: severe spasticity and pain syndromes.
Radiofrequency ablation: use of radiofrequency energy to destroy nerve fibers.
Indications: trigeminal neuralgia, chronic pain.
Thalamotomy: destruction of specific thalamic nuclei involved in pain transmission.
Indications: chronic neuropathic pain.
Selective dorsal rhizotomy (SDR): reduction of spasticity by cutting selected nerve rootlets in the lumbar region. Indications include cerebral palsy and spinal cord injuries. Advantages include high efficacy in severe forms and long-lasting results.
Implantation of intrathecal drug delivery pumps. The method involves implantation of a device that delivers medication directly into the cerebrospinal fluid. Indications include spasticity in cerebral palsy, spinal cord injuries, and multiple sclerosis. Advantages include targeted effect, fewer systemic side effects, and reduced overall drug dosage.
Orthopedic and neurosurgical procedures
Tendon and muscle lengthening. Used to reduce spasticity and improve limb mobility, most commonly in children with cerebral palsy.
Decompression of neural structures. Elimination of nerve compression (for example, in intervertebral disc herniation). Indications include radiculopathy and low back pain.
Preoperative preparation
Diagnostic evaluation:
- MRI and CT scans to visualize pathological changes.
- Electroneuromyography (ENMG) to assess nerve conduction.
Specialist consultations: neurologist, neurosurgeon, rehabilitation specialist.
Assessment of previous treatment efficacy: medications, nerve blocks, physiotherapy.
Postoperative rehabilitation
Physical activity: gradual increase in load under the supervision of a rehabilitation specialist.
- Physiotherapy: electrical stimulation, massage, therapeutic exercise.
- Cognitive-behavioral therapy. Assistance in adapting to functional changes after surgery.
- Regular follow-up. Adjustment of stimulators or pumps when necessary and monitoring of clinical progress.
Advantages of surgical treatment of chronic pain syndromes and spasticity
- High effectiveness in severe and treatment-resistant forms of pain and spasticity.
- Long-term or permanent therapeutic effect.
- Targeted impact on pathological neural structures.
Surgical treatment of chronic pain syndromes and spasticity in Belarus is an effective and modern approach aimed at improving the quality of life in patients with severe forms of these conditions. Advanced technologies such as neurostimulation and intrathecal drug delivery pumps allow significant symptom reduction with minimal side effects. The decision for surgical treatment should always be made on an individual basis in close collaboration with experienced specialists.
In Belarus, surgical management of chronic pain syndromes and spasticity is performed in specialized medical centers equipped with modern technology. Highly qualified neurosurgeons apply advanced techniques and an individualized approach for each patient. High-quality medical care combined with affordable costs makes Belarus an attractive destination for patients from different countries.
